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LECTURES 



-ON- 



PriRciples oP Osteopathy, 



-BY- 



■ (BHAS, HAZZA!(D, PH, B., D. 0. 

Lecturer on Prin(ii)les of Osteopathy, American School 
of Osteopathy. Kirksville, Mo., 1898, 



KIRKSVILLE, MO., 
ADVOCATE BOOK AND JOB PKINT, 

1898, 






-2. 



t^\ 



\ L -i I •' 



COPYRIGHT, 1898, BY CHAS. HAZZARD, D. O. 




mo COPIES RfceivEo. 



2nd COPY, 

189B. 



PRE^FAGE), 



The folio winp^ lectures were reported by the arraugement and for the 

convenience of the members of my class ; being printed and distributed to 

the students in the form, merely, of students' notes. The students saw fit to 

bring them out in bound form for the sake of preservation. Their distribution 

has been strictly limited to the students of the American School of Osteopathy, 

hence the little volume is to be considered only as one of students' notes, and 

in no sense as a published work. 

CHAS. HAZZARD. 

KiRKSViLLE, Mo., April 16, 1898. 



LECTUEE I. 

I. GENERAL CONSIDERATIONS. 

Learn to treat understandingiy ; imitate no operator's motions. Emerson 
says, ' 'Imitation is suicide." Take for instance a case of erysipelas. Should 
the operator treat about the sore spots, occurina: usually on one side of the 
face near the ear, and treat there alone, without giving attention to the general 
conditions of the patient, taking into account the affections of the kidneys, liver 
and other organs, in this trouble he would certainly not meet with success. One 
must understand the nature of the disease which he is treating. 

Make a correct diagnosis of the case. There are no two cases alike. You 
cannot take it for granted that one case which you receive to-day is like the case 
which you treated yesterday. Look over the case thoroughly' making an in- 
dividual diagnosis for it; likeness and unhkeness to other cases are incidental 
only. Make no diagnosis by telephone, as I knew a physician — a fellow towns- 
man of mine — to do once. Remember that a young doctor's success often de- 
pends upon how he handles a simple case. For instance headache, which al- 
though not always simple, is frequently so. Should you be called first upon a 
case of headache and treat it successfully, granting it was a simple case, your 
future success in that town in which you may be located, may depend upon 
that. I may cite here an incident told of Thoreau. It is said that, traveling 
upon a train one day he had occasion to lower the car window ; soon thereafter 
he w^as accosted by a manufacturer traveling upon the same train, who said he 
had noticed his delicate manipulation of that window and upon the strength of 
tha^ observation offered him a position in his manufactory. 

Have your theories, but stick to facts. Remember that you cannot always 
treat a case according to preconceived theories — that each case is peculiar to 
itself. Huxley says, "Theories do not alter facts, and the universe remains 
unchanged, even though texts crumble. 

II. GENERAL CONSIDERATION OF THE SPINE. 

Origin of the Spinal Nerves. (Holden) : "The origin of the eight cervical 
nerves corresponds to the interval between the occiput and the 6th cervical 
spine. 

"The origin of the first six dorsal nerves corresponds to the interval be- 
tween the 6th cervical and the 4th dorsal spines. 

•'The origin of the lower dorsal nerves corresponds to the interval between 
the 4th and 11th dorsal spines. 

"The origin of the five lumbar nerves corresponds to the interval between 
the 11th and 12th dorsal spines. 

'•The origin of the five sacral nerves corresponds to the last dorsal and 
first lumbar spines." 



Landmarks along the spine : Holden instances a median furrow caused 
by the prominences of the erectors spinge, which extend along the spme as far 
as the interval between the 5th lumbar vertebra and the sacrum. Hollows upon 
the surface correspond generally to prominences of the skeJeton, and vice versa. 
This is on account of the attachments by tendons to prominent skeletal points. 
Sharp friction will redden the spines of the vertebrae so that they can be count- 
ed and notice whether they are in line or not. The level of the 3d dorsal spine 
is the level of the beginning of the spine of the scapula. 

The level of the 7th dorsal spine corresponds to the inferior angle of the 
scapula. 

The level of the 12th dorsal spine corresponds to the head of the last rib. 

The level of the 3d costal space corresponds with the root of the spine of 
the scapula. 

The level of the 3d dorsal spine corresponds with the 3d intercostal space. 

The level of the 3d intercostal space corresponds with the level of the 
right and left bronchi, the right being nearer the posterior chest wall. 

The following is a convenient method for ascertaining the position of the 
12th dorsal spine : Have patient fold his arms and lean forward, thus bringing 
the spines of the vertebrte out prominently ; then the lower border of the trap- 
ezius muscle can be traced to the 12th dorsal spine. 

The kidney is best reached by pressure below the level of the last rib at the 
outer edge of the erector spinas. 

The tip of the crest of the ilium is about the level of the spme of the 4th 
lumbar vertebra. 

The ilio-costal space extends from the lower border of the 12th rib to the 
crest of the ilium, varying in width from the width of a finger to that of a 
band. So says Holden. I would caution you, however, in the former case to 
ascertain carefully whether or not there be a dropping of the ribs and altera- 
tion of the chest in its antero-posterior diameter. Such a condition, a narrow 
ilio-costal space, is usually accompanied by neurasthenia and kindred affections 
in the patient. 

In the depression below the occiput are found the edge of the trapezius 
muscle and the upper end of the ligamentum nuch^. 

The 2nd cervical spine is forked and rather prominent. The 3d, 4th and 
5th cervical spines are not usually made out, as they recede anteriorly from 
the surface. The 6th and 7th (prominens) are prominent. The spines of the 
dorsal vertebrae correspond with the heads of the ribs next above, e. g., the 
4th dorsal spine with the head of the 3d rib. But the 11th and 12th dorsal 
spines correspond with the heads of those ribs. 

III. ILLUSTRATIONS UPON THE SPINK. 

In the location of the atlas, it is felt only by making out its transverse 
processes, which are readily felt on each side between the mastoid process and 



the angle of the inferior maxillary bone ; the normal position being about mid- 
way between these points on either side. Should there be a deviation from 
the normal, either to one side or the other, anteriorly or posteriorly, or a twist 
in either direction, it is readily made out by the trained touch. 

Peculiar vertebrae are found along the spine, viz. : the 2nd, 6th and 7th 
cervical, 12th dorsal and 5th lumbar. The 2nd cervical is noticeable because 
of being slightly prominent and bifid. The 6th and 7th cervical because of 
slight prominence. The 12th dorsal because it often marks what the Osteopath 
calls a "break," a separation of the spines of the vertebrge occuring betv^een 
the 12th dorsal and 1st lumbar. This is a point of importance. The same is 
the case with the 5th lumbar, there often being a break between its spine and 
the superior crest of the sacrum. 

The ligamentum nuchas is of great importance to the Osteopath. You will 
remember that it extends from the occipital protuberance to the 7th cervical 
spine. You must learn to recognize it by touch. Frequently it will contract 
and is the sole means of reheving headache when stretched. 

HOW TO EXAMINE A SPINE. 

In the first place, notice if at any point along the spinal column the spine of 
any vertebra is deviated laterally. In such a case there is usually a sore spot 
in the muscles upon the side of the spine toward which it is deviated. In the 
neck we do not depend upon the prominences of the spines behind, to diagnose 
a slip in the vertebrae, but by turning the head to one side, thus bringing into 
prominence the transverse processes of the vertebrae, we may ascertain whether 
or not one is prominent anteriorly or posteriorly ; in such a case a sore spot 
usually is found at the end of the transverse process of the vertebra. Spines 
may be separated at any point along the column ; you may find the spines ab- 
normally far apart. We occasionally find what is designated a smooth spinal 
column, by which I mean that a spinal column may have its vertebrae so pro- 
tected by the thickening of the ligaments or other structures as to obviate the 
ordinary feeling one experiences in running the hand down the spine. For 
such a condition I have somewhat arbitrarily adopted the term, "a smooth spinal 
column." The natural curves of the spine may be changed, as will readily be 
observed by you in practice. I do not speak here of spinal curvatures, not at 
all ; but frequently a slight, or it may be a marked, deviation from the natural 
curve described by the normal spinal column, will be noticed. Hence, if there 
is a break, ligaments often cause lesions in that they may, by the displacement 
of the bony parts to which they are attached, be dragged across some important 
structure, such as a nerve or a blood vessel, thus compressing it and abridging 
its function. 

These points upon how to examine a spine will be continued m further 
lectures, and their significance to the Osteopath be fully considered at those 
times. 



LECTTJEE 11. 



1. Centers of the Sympathetic: — These centers are of vast import- 
ance to the Osteopath. Eeasoning according to centers is frequently with 
him going from effect back to cause, and of course from periphery back to 
center. It instances one of his modes of thought; and to acquire this habit of 
mind and of thought is frequently the basis of our professional success. There 
is a given definite center for the activities of a given point or organ. For in- 
stance, there is a center upon which we work to affect the kidney; or, we may 
say there is a given definite center for each physiological process. As for in- 
stance, there is a center upon which we work to affect the general circulation. 
In the absence of a discoverable lesion, which frequently occurs, the Osteo- 
path' s work must be largely on the centers, sometimes entirely so. Even 
when the lesion has been found and attended to, he must give much attention 
to the particular center governing the part affected. Eemember, it is going 
back to first principles. I would beg you to remember that the following 
points have been gathered from various sources; from the experience of 
operators, from lectures heard from others, from books, from conversations, 
from my own personal experience, and that I cannot in every case give you 
the authority for the center designated. I speak of the centers more in an 
Osteopathic than in a purely physiological sense, meaning that point along 
the spine which has designated itself as a center in response to the work upon 
it; results justify such statements. In other cases, of course, these so-called 
centers are the physiological centers indicated by the authorities. 

Centers of the Sympathetic. (For the following centers I am especially 
indebted to Drs. Alice Patterson and C. P. McConnell.): 

Third cervical vertebra, middle of neck. Above, manipulate upward; 
below, downward. 

Third, fourth and fifth cervical, origin of the phrenic — hiccoughs. 

Third, fourth, fifth and sixth, vaso motors. The superior cervical 
ganglion is connected with the first to fourth cervical nerves. This ganglion 
lying opposite the second and third cervical vertebrae. The middle cervical 
ganglion connected with the fifth and sixth cervical nerves: this ganglion 
lying opposite the sixth and seventh cervical vertebrae. 

The point between the first and second dorsal vertebra^, the center to the 
lungs. 

First rib for heart flutter. 

Between second and third dorsal, ciliary centei', and recti of the eye 
ball. 

Between fourth and fifth dorsal on right side for the stomach center: on 
the left the pneumogastric for the i)yloric oriii(H\ 

Fifth and sixth dorsal, vaso motors to the arm. 



Fifth, sixth, seventh and eighth dorsal, great splachnics. 

Eighth dorsal, center for chills. 

Between eighth and ninth dorsal, center for liver. 

Mnth, tenth and eleventh dorsal, small splachnics. 

Twelfth, smallest splachnic. 

From a point between the seventh cervical and first dorsal to a point be- 
tween the eighth and ninth dorsal, the center for the anterior dorsal branches 
which convey dorsal branches to pulmonary center. The posterior pulmonary 
plexus connects with the second, third and fourth ganglia of the sympathetic. 
The anterior pulmonary plexus from the pneumogastric and the sympathetics. 
Yaso motors to the lungs have been found in the dog from the second to the 
seventh dorsal. This corresponds to the centers upon which we work in man 
to reach the lungs. 

Second lumbar vertebra, center for parturition, micturition, defecation. 

Third lumbar, coeliac axis. 

Point between fourth and fifth lumbar vertebrae, defecation. 

Fifth lumbar, center for hypogastric plexus. 

From a point between the second and third sacral to a point between the 
fourth and fifth sacral, center for the neck of the bladder. 

Fourth sacral, center to relax vagina. 

Fifth sacral, sphincter ani (the latter two are spinal branches.) 

The term ''cervical brain" has been applied by Dr. Still to the region 
lying between the first cervical vertebra and the fourth dorsal vertebra. The 
term "abdominal brain, " has been applied by him to the region lying be- 
tween the first dorsal and third lumbar vertebrse. Pelvic brain, to that re- 
gion lying between the tenth dorsal and fifth lumbar vertebrae. 

Other centers of the sympathetic are as follows: 

Sensation, atlas to fourth dorsal. 

Motion, fourth dorsal to sixth dorsal. 

Nutrition, sixth dorsal to coccyx. ^ 

These three centers are spoken of by Dr. Still, not fully understood by 
me, and are still food for thought. 

Centers in the medulla as follows: Cough, sneeze, vomit, respiration, 
salivation, phonation and deglutition, renal center, center for spasms. 

Yaso motor centers: Medulla, second to sixth dorsal, fifth lumbar. 

(I remember once when sent to attend a case of Dr. Hildreth's, his words 
to me were, ' 'Eeduce the fever by desensitizing in the superior cervical 
ganglion, the middle dorsal, and the lower lumbar.") 

Cilio-spinal center, fifth cervical to the second or fourth dorsal. 

To dilate the iris and contract the pupil, from fifth cervical by the su- 
perior cervical ganglion. 



6 

Heart center, in the corpora striata; first rib; first, second, third, fourth 
and fifth dorsal vertebrae. 

Parturition, second lumbar vertebra. 

Cervix uteri, ninth dorsal. 

Blood supply to ovaries, eleventh dorsal. 

Uterus, second lumbar, second and third cervical vertebrae, also from 
h;^^ogastric plexus by the lower dorsal and four upper lumbar nerves and 
through the splachnics. 

Yaso motors of the head: The eye, ear, salivary glands, tongue, brain, 
etc., are all reached at the superior cervical ganglion. Here also a general 
vaso motor effect to the body is claimed. Vaso constrictors for the head are 
said to exist at the fifth and sixth dorsal vertebrae. Stimulation of the su- 
perior cervical ganglion has a vaso constrictor effect upon the vessels of the 
retina, probably through its ascending branch and its connection with the 
fifth nerve. 

The lungs, second to seventh dorsal vertebrse. 

Jejunum, first to fifth dorsal vertebrae. 

Small intestine, above first lumbar. 

Large intestine, first to fourth lumbar. 

Liver, from the splachnics, vagi, and inferior cervical ganglion. 

Kidneys, at the sixth dorsal, second lumbar, renal splachnics and super- 
ior cervical ganglion. 

Spleen, splachnics on the left side, eighth to twelfth dorsal. 

Lower limbs, second dorsal down. 

Circulation, superficial fascia (the second dorsal for the upper part of 
the body, the fifth lumbar for the lower part. ) 

Valves of the heart, second to fourth dorsal. 

Ehythm of the heart, third and fourth cervical. 

The genito spinal center and the lower hypogastric plexus and plexus to 
intestinal canal, bladder and vasa deferentia, at the fourth and fifth lumbar. 

Bowels, peristalsis, ninth, tenth and especially the eleventh dorsal. 

Larynx, first, second and third cervical. 

in. How TO Examine A Spine. (Continued.) — Look for the lesion 
always. It may be high above or much below the usual center. For in- 
stance, we may work as high as the lower dorsal for sciatica, its center being 
in the sacral plexus. This lesion may be in the nature of a strain, congested 
muscle, a dragging of ligaments, a tightening of the ligaments, thus drawing 
the vertebrae together. It may be in the nature of a sprain or break. It 
may even be absent. But remember that your duty is not done until you 
have thoroughly looked for the lesion. A congestion of the spinal muscles is 
often noticed on examination; it may be of the superficial muscles or of the 
deep muscles; it may be primary or secondary. By primary. I mean a con- 



gestion to tlie muscles set up by some direct effect upon them, e. g. the effects 
of a draft or a blow. This congestion involves the peripheral termination of 
the spinal nerves, acting through them and through their sympathetic con- 
nections to affect some internal viscus. By secondary, I mean the reverse, 
for example, the stomach may be affected, and the effects may be transmitted 
over the solar plexus back along the splachnics thence to the spinal nerves 
with which the splachnics are connected, thence back over the peripheral ter- 
minations of these nerves to the skin and muscles of the back. You may, in 
your examination of the spine, find that it is frequently rigid, not pliant; on 
the other hand, you may find that it is quite relaxed; abnormally mobile. 



LECTURE III. 



I. Further Considerations of the Sympathetic System : — 1 have al- 
ready spoken of the importance that we as Osteopaths attach to centers, espec- 
ially to those centers which I have given you along the spine. The theory of 
our work upon them and their significance in connection ^ith disease we shall 
take up later. I may m passing, however, say that they are one of the most 
important things by which the Osteopath has to work. The same is true of 
the sympathetic s^^stem in general. The general anatomy of the sympathetic 
system is doubtless already known to you, but there are points which I wish to 
recall to your attention and cite you their significance from our stand point. 

Points FROM Quain: — The sympathetics are connected with the spinal 
nerves by white and gray rami communicantes. The white are meduliated and 
pass from the spinal nerves to the sympathetic ganglia. Some white fibres 
pass from the ganglion to the efferent ramus. Some end in the ganglia; they 
may ascend or descend in the sympathetic cord to higher or lower ganglia, 
thus connecting with several, and being in this manner widely distributed to 
the sympathetics. The gray rami communicantes are non-medu Hated, or pale. 
They pass from the sympathetic ganglia back to the spinal nerves, the reverse 
of the white They arise from cells in the sympathetic ganglia. They may, 
rarely however, run in the sympathetic cord to another ganglon, and then 
emerge to take their course to the spinal nerves. They enter the anterior pri- 
mary division of the spinal nerves, divide to send some fibres centrally toward 
the cord, some peripherally through the spinal nerves to the general system. 
Those gray fibres of the sympathetic which pass centrally join in part a re- 
current branch of the special nerve and with it run to supply the vertebrae, 
the dura mater, the Hgaments and blood vessels of the spinal canal. Other 
filaments pass over the bodies of the vertebra and supply the intercostal and 
lumbar arteries and veins, ligaments and bones. Thus, the central distribution 



of the sj'mpathetic nerve is of great importance to the Osteopath in his work of 
building up a weak or defective spine, and helps, in part at least, to explain 
the wonderful results he obtains in that department of his work. Those sym- 
pathetic fibres which pass dietaliy in the anterior and posterior primary divi s- 
ions of the spmal nerves supply the blood vessels of the body walls and mus- 
cles with vaso-motor fibres, and the sweat glands of the skin with secretory 
fibres, and the hairs with pilo-motor fibres. 

Here again the sympathetic system becomes significant from the Osteo- 
pathic point of view, and aids in explaining the reason for the immediate re- 
sults attained in keeping the skin, the so-called lung, and superficial fascia in 
good working order. It is important in cases of blood and skin diseases and 
in fevers. The centers for the superficial fascia, you will remember are the 
2d dorsal and the oth lumbar. The Old Doctor, who in the past few months 
has been making special studies upon this subject, attaches great importance to 
superficial fascia. Of equal, or perhaps greater importance, finally are the 
visceral distributions of the sympathetic nerves, there being efferent oranches 
running forward from the sympathetic ganglion to the great pre-vertebral 
plexuses, the cardiac, solar, hypogastric and pelvic plexuses, so-called primary 
plexuses, e. g., the phrenic, renal, spermatic, coeliac, superior and inferior 
mesenteric, aortic, hemorrhoidal, vesical, etc. Their importance to the Oste- 
opath lies in the fact that through them he may regulate the actions of the in- 
ternal viscera to a wonderful degree. Thus we stumble onto the paradox that 
a man's own internal, organic life may come under the control of another to a 
greater or less extent. 

Some gray fibres pass from the ganglia out over the efferent rami. I have 
placed here upon the board a diagram from Quain in which you note illustrat- 
ed the points which I have brought out concerning the gray and white rami 
communicantes and their connections with the anterior and posterior divisions 
of the spinal nerves, their course toward the cord and also the efferent rami 
running outward to the great prevertebral plexuses. The medullated fibres, 
that is, those of the white rami, may be, 1st, sensory, running from the poster- 
ior root of the spinal nerve; 2nd, vaso and viscero-constrictors, from the 9th, 
10th and 11th cranial nerves ending in the sympathetic ganglion, whence their 
action is carried out through pale fibres rising from cells in the ganglia. ■ These 
fibres thus have become demeduUated by passing through the sympathetic gan- 
glia, 3rd vaso dilators from the anterior and posterior spinal roots, and from 
the Oth, 10th and 11th cranial nerves, pass through the sympathetic ganolia. 
do not connect with any nerve cells therein, and reach the organ they supply 
as medullated nerves. 

II. Landmarks. A tabular plan of the parts opposite the spines of the 
vertebrae. After Holden. Opposite 7th cervical spine, apex of lung, hiirher 
in females. 



Opposite 3rd dorsal, aorta reaches spine, apex of lower lobe of lung, angle 
of bifurcation of trachea. 

Opposite 4th dorsal spine, aortic arch ends ; upper level of heart. 

" '' 8th " " lower level of heart ; central tendon of diaphragm 

'• " 9th " " oesophagus and vena cava perforate diaphragm; 

upper edge of spleen. 

Opposite 10th dorsal spine, lower edge of lung; liver comes to the surface 
posteriorly; cardiac orifice of stomach. 

Opposite 11th dorsal spine, lowest part of pleura; aorta perforates dia- 
phragm ; pylorus. 

Opposite 1st lumbar spine, renal artery; pelvis of kidney. 

" 2nd " " termination of spinal cord; pancreas; duode- 
num just below ; receptaculum chyli. 

Opposite 3rd lumbar spine, umbilicus : lower border of kidney. 
" 4th '* " division of aorta; highest part of ilium. 

Apex of lung is most liable to disease ; may be examined by percussion at 
external end of clavicle. 

Angle of junction of trachea is in some cases opposite the 4th dorsal spine. 
This angle corresponds in front with the junction of the first and second parts 
of the sternum. As to the kidney, its upper border may be as high as the level 
of the space between the 11th and 12th dorsal spines. Its lowei border may 
extend as low as the 3rd lumbar spine. 

III. How TO Examine a Spine. (Continued.) I spoke in a previous lec- 
ture of variations of curves of the spine from the normal. A few more words 
concerning this. There may come to your notice in your examination of a 
spine a flattening between the shoulders ; on ths contrary, the tendency there 
may be posteiior decidedly. The same condition may prevail immediately be- 
low the shoulders about the middle of the back. You may have a posterior 
flattening of the lumbar region, which naturally, as you know, is curved an- 
teriorly. But, on the other hand, you may have too pronounced a tendency 
anteriorly m this region. Again, you may have all of the normal curves of the 
spine lessened, leaving what we describe as a straight spine. You will readily 
see that in such a condition the whole equilibrium of the body is more or less 
disturbed. You may find the sacrum itself too prominent posteriorly, or too 
flat, thus increasing or diminishing the autero-posterior diameter of the pelvis. 
Finally, you may find that the coccyx has been bent to one side, in which case 
it may be the cause of piles ; it may be bent forward, as frequently you will 
find, from horseback riding, etc. In such a case it may become a mechanical 
impediment to the passage of fecal matter, thus mechanically causing consti- 
pation. , Remember, please, that in calling your attention to these points in 
how to examine a spine, I have left aside the subject of their significance. 
That subject will be fully considered in later lectures. 



10 
LECTURE IV. 



I. HOW TO EXAMINE A SPINE (CONCLUDED.) 

There are a few more points regarding tiie abnormal curves of the spine, 
which I think will be useful to you — flattening between the shoulders or pos- 
terior tendency there — the posterior tendency that we frequently meet with 
along the lumbar region or flattening there. Then the different positions that we 
find upon examination that the coccyx has assumed, and the different positions 
m which we find the sacrum itself. Also I may mention the fact that there 
may be considerable variation in the curves of the spine, so that you may have 
quite a straight spine by the time you have looked over all the points. Hence, 
the natural equihbrium may be destroyed in that way. 

There is one other point which you will probably find, and that is that a 
vertabra may not only be sUpped from side to side, but by following the curve 
along the spine we may at any point come to a vertebra extending backward — 
not only one or two, but several may be displaced backward ; or you may find 
a single one displaced anteriorly. I was treating a case not long ago in which 
one of the dorsal vertebrae was pushed anteriorly, and it had an effect upon the 
kidneys. It generally affects the center near where it occurs. 

Hilton says that frequently he has found that a pressure of the head 
straight downward on the spine, and then rotation from side to side will cause 
a sensation of pain in the cervical region, and will be evidence of disease there, 
when one has not been able to find it by any other diagnosis. He has found 
that the general symptoms justified his locating the disease in the upper cer- 
ical vertebra. 

There is another point that is not of very much importance to you, but 
you should understand it, because your patients will notice it probably and are 
apt to ask you to explain why it should occur. That is, as you work along the 
spine you may hear sertain noises, somewhat like poppmg. You will find them 
all along the spine, sometimes distinctly on one side, sometimes distinctly on 
the other. Also when you are working in the neck, moving it from side to 
side or in any way, you may get a click. Or the patient may hear it when he 
is turning his head from side to side. Now the reason as to why you hear 
these noises along the spine is explained differently m the different regions. 
In the dorsal region there are three things that may move. The whole verte- 
bra may be moved; of course there is inter-vertebral motion, but we do not get 
many of these noises from that cause, on account of the way they are bound 
together, being connected by inter-vertebral discs, with no synovial mem- 
brane. The second place in which you may get motion is between the head of 
the rib and its articulation with the bodies of the vertebrjv and the intor-verto- 
bral substances. Then, in the third place, you may have motion between the 
tubercles where they articulate with the transverse [U'ocessos of the next verie- 



11 

bra below. In the neck the only place you are liable to get any click is be 
tween the articular processes of the vertabrse. These noises in the spine are not 
of much significance, but you will meet them and of course would like to un- 
derstand them for the patient's sake, because if they find you do not under- 
stand these things, you may lose a valuable patient. 

II. OSTEOPATHIC SIGNIFICANCE OF POINTS OBSERVED IN EXAMINATION 

OF THE SPINE. 

After understanding fully how to examine the spine, your next question 
naturally is, when I have found these things along the spine, what is their sig- 
nificance? If we do not know what they mean they are useless to us. When 
once you know the results of certain lesions it does not take ^-ou long to find 
the lesion. I have therefore for the present dropped the subject of the sympa- 
thetic nerve, and have decided to devote one or two lectures to the general 
consideration of the osteopathic significance of the points which we find in our 
examination of the spine. Remember, please, that this cannot be given to you 
in full by lectures, and that you will only recognize the full significance in 
your practice. I can make it plainer later when we take up particular cases. 
What I want to do is to show you the significance of certain points, and to get 
you into the habit of osteopathic reasoning — to show you how we look at these 
things, and the process of thought followed. 

The first point, then, is as follows: In general, a lesion along the spine, 
whatever its character, affects the center at which it occurs, and thus may affect 
cerebro-spinal life or sympathetic life, either or both. The former if it is more 
superficial, in general, and the latter if is deeper in general. As to the charac- 
ter of the lesion, it may be of any form found in the examination of the spine. 
As to locality, it may be either superficial or deep You may find along be- 
tween the shoulders a flattening, which may extend as low as the 8th dorsal, 
and interfere with the centers for the stomach. If it be serious in character it 
will extend deep enough to affect the sympathetics, and thus organic life, and 
you will probably have stomach trouble. If it is not deep enough to affect 
the sympathetic life, it may affect the cerebro-spinal life and you will have a 
lame back; or if it is in the region of the 6th or 7th dorsal, pains may run 
around the rib? and meet over the pit of the stomach at tne abdomen. The 
character of the injury may be such that it affects deeper structures, or it may 
have a more superficial effect. 

The next point in osteopathic reasoning is the consideration of the amount 
or intensity of life displayed in any given condition. This is an important 
point, and perhaps not clearly expressed, but I will try to make it plain to j^ou. 
You may have a rigid spine, or you may have a relaxed spine. Now, in gen- 
eral, the process of reasoning which the osteopath uses is about as follows: 
The fact that the spine is relaxed shows a lack of nerve force, a lack of life 



12 

there. On the other hand, if there is ^reat tension along the spine, the spine 
is closely bound down and held together by the ligaments, so that you have a 
rigid spine with little motion, the reasoning would be, to some extent at least, 
that there had been an injury to the spine or a strain that had resulted in di- 
recting too much nerve force to that part of the body for a shorter or longer 
period of time, which resulted in throwing too much food supply there, caus- 
ing a thickening of the ligaments binding the vertebra together. Of course 
collaterally, when too much life and vigor was thrown to that part it was rob- 
bing some other point. 

Take several illustrations to^make this clear : You may have a tension in 
the spinal muscles behind. It may seem queer to you, or to your patients, 
for you to tell them that a muscle is contracted, congested or drawn, and has 
remained that way. It is hard to believe but such is the fact. What does 
such a condition argue to your mind? Simply that there is too great an 
amount of nerve force there, which, reacting upon the muscles, causes them to 
contract. In that case your nervous force is in the nature of a violent stimu- 
lation to those terminal sensory nerves. On the other hand, it may be second- 
ary from the condition of an internal viscus. There may be some visceral dis- 
ease, say stomach trouble, which would be reflected from the solar plexus out 
along the splanchnics to those spinal nerves, and through those spinal nerves 
back to their distribution. There may be a misdirection of the nerve force or 
life, which life is sent to the spinal muscles, and you have too great a supply 
of nerve force along the spine. We reason according to the amount of nerve 
force or life sent to these points Again, when you make a digi^-al examina- 
nation of the rectum, you may find that there is some irritation which acts in 
the nature of a stimulation to the nerve force which supplies that rectal sphinc- 
ter, and IS causing it to contract. On the other hand, you will find in some 
examinations Ihat there is no force put forth whatever, the sphincter is relaxed, 
and in such cases it is very likely that the patient is suffering from inconti- 
nence of the fecal matter. In the one case there is too much nerve life, in the 
other too little. This may also result from visceral troubles. In a case of 
diarrhoea the osteopath first examines to find some lesion along the spine at 
the 9th, 10th, or 11th dorsal, causing too much nerve force to be directed from 
the sympathetic system to the intestine so that there is too rapid peristalsis and 
also too great a secretion of watery matter. There is too much nerve life 
there, or there could not be too much motion. On the other bond, in consti- 
pation, either something has happened to deaden the nerve force or to dissem- 
inate nerve force to other parts of the body so that you have too little loft. 
You have not enough energy to pass the fecal matter along its course, and the 
result is a case of constipation. This is not a full explanation of all these 
cases, but I simply use them as illustrations. You will find this a vaUiable 
point in osteopathic reasoning. In the former case the osteopath adopts suc^a 



13 

measures as will disseminate the nerve force and equalize it throughout the 
body. In the latter case he directs his attention to a rational means of renew- 
ing the nerve force which is lacking at the given point affected. 

When you find upon examination that the spines are separated, what 
is your conclusion ? Simply that some lesion has caused a relaxation. There 
is too little life, and hence a separation. This may impinge upon the nerve 
centers and there will be trouble according to the center over which the lesion 
has occurred. In a case of a ''smooth spine", where every vertebra seems to 
be jammed down close to its fellow, there seems to have resulted a contraction 
of the ligaments connecting them, affecting almost ail of the centers along the 
spine to a greater or less degree ; there may result neurasthenia, a general lack 
of nutrition, general eye troubles, nervous troubles, circulatory affections. 

A spine twisted leads us to look at the center which is affected. This 
brings us to the tension on the ligaments which I have mentioned a time or two 
before. When we have a case in which there is a twist of the vertebra, we rea- 
son from the position of parts as to what ligaments are affected. Suppose, for 
instance, that a vertebra is twisted so that a spine instead of being exactly in 
line, is turned toward the right, then what is the condition of the ligaments? 
The anterior and posterior hgaments along the bodies of the vertebra will be 
obliquely upon a tension, the supra-spinous and inter-spinous ligaments will al- 
so be upon a strain, the ligamentum subflavum on the left side will be tightened 
and that on the right side tightened also ; the inter-transverse ligaments on 
each side will be tight, and extend one forward and the other backward. This 
is the method of reasoning ^^ou should adopt, and you should reason from the 
symptoms as to what nerves are affected. You will find that the ligaments 
may draw across nerves in such a way as to affect nervous life, either spinal 
alone or sympathetic through the spinal. 

I mentioned along the spine certain peculiar vertebrae. In regard to the 
second cervical vertebra, if you are a young Osteopath and examining your 
first patient, you will be sure to find something wrong with that vertebra. 
Please bear in mind that it is not like the others, but has a prominent forked 
spine. You may make the same mistake with the 7th cervical. You should 
acquaint yourselves with these natural conditions, so that you can judge cor- 
rectly as to any change from the normal condition. Then bear in mind also 
that the 12th dorsal and the 5th lumbar are very apt to be points of mischief. 
and a separation is very hkely to take place at those points. Between the oth 
lumbar and the sacrum is a point which is frequently affected and which makes 
a great deal of trouble. The 5th lumbar may be anterior or it may be posterior, 
and in such a case it depends upon your other symptoms as to how you will di- 
agnose your case. This may cause trouble with the viscera supplied by the 
sympathetic nerve, there may be uterine trouble, trouble with the generative 
organs of either sex, paresis, paralysis, or sciatica. 



14 

In these variations from the normal curves of the spine in general the sig- 
nification to the Osteopath is as follows : If there is a flattening or posterior 
tendency between the shoulders, you will generally fluid that the patient has 
heart or lung trouble. You will expect to find some lesion there affecting those 
organs, which acts directly by impinging^ upon the nerves or by changing the 
position of the ribs. There may be a change in the first or second rib, causing 
heart trouble; of the 7th rib, causing asthma. You may have heart or lung 
trouble there, or if it is as low as the 8th dorsal you may have stomach trouble, 
or there may be renal trouble caused by a lesion as high as the 2nd dorsal, or 
sciatica as high as the 2nd dorsal. You must reason according to the centers 
affected. If there is a change from the natural curve in the region of the 
splachnics from below the shoulders to the first lumbar, then look for such 
troubles as intestinal affections, renal troubles. This same reasoning apphes 
in general to the sacrum and coccyx. The coccyx may cause either mechanic- 
al troubles, such as piles and constipation, or sympathetic trouble and affect 
the internal viscera in that way. 

The osteopath finds the atlas of great importance to him in his work for the 
reason that it may impinge upon certain nerves, aad may affect spinal centers, 
or it may act in such a way as to deprive the brain of its supply of nutrition, 
and thus lead to results which are very significant to the osteopath. It may act 
in such a way as to shut off the blood supply to the brain and it may affect 
every center in the brain. Hence, you may commonly find that vour patient 
has been unable to speak for a long time, or has been unable to hear plainly, ©r 
he may have become insane. It may also impinge so much that it presses on 
the cord and robs it of its nutrition, so that there may follow various spinal 
troubles. It may press upon it on one side, causing hemiphlegia, the patient 
having no use of one half of his body, the legs and the arms being small in the 
case of a child, where the development has been impaired. This is the Osteo- 
pathic way of looking at a case when you find that the first cervical has been 
slipped. I had a case of this kind not long ago. The result was that the child 
could not speak; it could say ''Mamma" but everything else that it said was 
just a peculiar sound, it could not articulate except that single word. In addi- 
tion to that, its left side was paralyzed, or there was a paresis there, the child 
limped, the leg was short and the arm was drawn up. The wiiole trouble there 
was really at the first cervical vertebra, which was slipped, affecting the spinal 
cord nnd the bram, either through its blood supply or directly by impingement. 

What IS the significance of the noises that we find along the spine? Usu- 
ally nothing whatever. You may find noises all along the spine in a man who 
is quite healthy. But, on the other hand, it may have considerable significance 
and these the Osteopath should always take into consideration. As I have ex- 
plained, either the heads or tubercles of the ribs may be slipped, or the position 
of the vertebra may be changed, or the articular processes may cause a great 



15 

deal of trouble in the neck. The Osteopath m thinking of these things thinks 
of the normal anatoiny of the part. He says, here is a point which may be sub- 
jected to a strain or twist, it can be extended or shortened to some extent, so 
that these are movable points ; and being points at which a strain may occur, 
are points which are hable to disease. You will find this of great significance 
in the etiology of spinal curvature. Along this line I simply want to quote 
from Halliburton. He says "Disease of the spine may begin in the vertebrae or 
in the inter-vertebral substances; I thinV on the whole, m the intervertebral 
substances where it is joined to the vertebrae." His editor. Dr. Jacobson, says 
that his view is supported by the fact that the junction of a more with a less 
elastic body is the weakest spot and therefore receives the full effect of the 
strain. He instances the case of an atheromatous artery, the weakest portion 
is where the diseased wall joins with the more elastic substance of the healthy 
wall, and it is at that point where the real strain comes and where an aneurism 
is likely to occur. Hence, as I explained, here arises for the Osteopath the 
significance of a distorted vertebra, causing a slight irritation of the parts 
throwing to much blood and nerve force and life there and setting up some ir- 
ritation, causing a thickening of the ligaments and perhaps a permanent inju- 
ry to certain parts, especially the nerves. 

The Osteopath realizes that the ill effects of injuries along the spine are 
not dependent upon their great extent. That is to say, you may have a very 
bad curvature of the spine which is congenital or there may be a very bad cur- 
vature of the spine which had come on through years, without very serious 
trouble following. In such cases where the curvature has covered a very long 
period of time, or where a child has been born so, the parts become adapted to 
the variation from the normal, and such persons may go through life with 
good organic life. I have seen some cases of dwarfs or hunch backs who had 
very good health ; and, reasoning from the Osteopathic standpoint, we some- 
times wonder why it is in such pronounced curvatures of the spine, the, person 
does not have stomach trouble, bowel trouble, why the kidneys are not affect- 
ed, and so on. On the other hand, you may have a man with a sound back, 
but who has a little twist of one vertebra, which may make him a great deal of 
trouble. So the osteopath reasons not from the great extent of th^ departure 
from normal, but from the center affected and from antecedent conditions. Hil- 
ton saj^s that almost all diseases of the spine are the result of some slight strain 
or some slight accident, and that is what the Osteopath finds ever}^ week of his 
practice. A man will come into your office in trouble ; you will find a spinal 
lesion. He knows he never fell, a horse never kicked him or anything of that 
kind, but in about three weeks he will come back and tell you that he went 
home and talked it over with his wife, and she reminded him of that time he 
fell down the court house steps, or something of that kind. He has had some 
accident which he has overlooked, but which has caused some slight lesion of 



16 

the spine, taking time to develop, but which has at last caused considerable 
trouble. Hilton also instances a very serious case in which the lesion of the 
spine was not discovered at all ; it was only after the patient had been fourteen 
years a paralytic and died that post mortem revealed the fact that the 5th, 6th 
and 7th cervical vertebrae had been ankylosed. The fall which caused it was 
a fall of forty feet upon his back and neck ; upon examination of the patient 
he was unable to find any lesion in these parts at the time. So the lesion may 
not be discoverable. 

Once more, Hilton says that be believes many cases of spinal diseases are 
due to to a slight injury which has been overlooked or to exercise persisted in 
after fatigue, A man falls down, says he has not been hurt, gets up and rubs 
himself to restore circulation, and thinks nothing more of it; but, as Hilton 
says, very slight injuries may cause very serious results, and the osteopath has 
to take all these things into consideration, and reason accordingly. 



LECTURE V. 



At the last lecture I called your attention to how to examine the spine, 
concluding that subject. I also took up the osteopathic significance of certain 
special points which we had before noticed in our examination of the spine. 
In general, a lesion affects a center over which it occurs. The osteopath rea- 
sons from the amount of intensity of nerve force displayed at any point. Spines 
may be separated or approximated. I called attention to the special vertebra, 
the 2nd and 7th cervical, and lesions at the 12th dorsal and 5th lumbar, and 
instanced the results of such lesions. I called your attention to the displace- 
ment of the atlas, stating that it was of great significance to the osteopath, as 
it may shut off blood supply to the brain and may impinge upon the cord, caus- 
ing serious troubles. I also called your attention, finally, to the fact that the 
osteopath does not measure the injury by its vast extent, instancing the case of 
a hunch back with good organic health, versus the case of a man with a slight 
shp or twist of one vertebra having great trouble. 

I wish to-day to continue this line of thought, taking up, then, as the head 
of this lecture ; The further consideration of the osteopathic significance of 
points in diagnosis. I failed to explain fully to you the signiticane of the 
clicking in the neck. From what I said you may have gathered the impression 
tbat it has no significance, or very slight, as those noises which occur lower in 
the spine. Such is not the case, however, if you hear a near click, the reason 
is that something has shut off the blood supply, it may have been a little strain, 
a congestion of tbe muscles, anything that will produce a tension over the 
blood vessels, or affect their vaso-motor fibres, causing a constriction and shut- 
ting off the blood. This may prevent the right ainouul of lubrication being 



17 

deposited in the synovial membrane between the articular processes of the ver- 
tebra, hence, yon have the vertebra too close together, and the patient in turn- 
ing his head, or upon its being turned by the operator, elicits a click or grat- 
ing, and the patient wonders what that is. To you such noises are of consid- 
erable significance. 

You may find it useful to consider the various troubles, w^hich you will 
find in your prrctice in relation to the plexuses from which they arise, and if 
yon adapt yourself to this habit of thought, and at once think, when you see 
trouble in one part of the body, where that may have come from, what plexus 
is affected, and what region in the spine, I think it will be of considerable use 
to you. Now, there may be lesions of certain groups of nerves, — the upper 
cervical group of nerves, those from the first to the fourth inclusive, may be 
affected b}- spasms, by convulsions, or by paralysis in general. I wish to call 
your attention to some points in relation to the distribution of nerves, and 
show you how important it will be to you as osteopaths to have a good knowl- 
edge, a knowledge which you can quickly call into use, of the distribu- 
tion of the various nerves in the body. You may have a pain in the ear 
— the person whom it affects ma}^ describe it as an ear-ache. If this ear- 
ache occurs upon the anterior pendulous portion of the ear, or upon the poste- 
rior aspect of the ear, you will have to refer that pain to the 2nd cervical nerve, 
which supplies those parts. If the ear-ache is in the canal of the ear, or the 
upper anterior portion of the ear, you will have to refer that trouble to the 5th 
cranial nerve. Hilton states how it was that he happened to find so definitely 
just how these nerves were distributed to the ear. The case was that in which 
an attempt had been made to cut a person's throat; the auricular branch of the 
second cervical nerve had been divided so that sensibility had entirely departed 
from the posterior and lower parts of the ear. By pricking very carefully over 
the whole surface of the ear he found just the distribution of the nerves. You 
mar have the ear-ache and the tooth-ache. And why? Simply because the 
5th nerve supplying the auditory canal supplies also by the superior and in- 
ferior maxillary branches, the teeth of the upper and lower jaws respectively. 
You may have ear-ache associated with disease of the anterior third of the 
tongue, simply because the 5th nerve, which supplies sensations to the anterior 
third of the tongue also supplies the auditory canal. Pain in the anterior 
lateral part of the scalp, over the temples, pain in the face eyes, nose, tongue 
and teeth j^ou refer to this same 5th cranial nerve. On the other hand in 
case the pain is in tha back of the scalp, we have two areas, one supplied by the 
great occipital nerve, and one b}^ the small occipital, branches of the 2ud cer- 
vical nerve. So it is that you have these areas of distrubution given so that 
3'Ou can reason and thus refer pains in a particular part back to the origin of 
the nerves. Both the 5th nerve and these upper cervical nerves are readily 
accessible to the operator. You thus see what the significance of these things 



18 

are to the osteopath m enabling him to make a correct diagnosis. If he is 
not acquainted with the distribution of these nerves he is not able to trace back 
and find the seat of the lesion. So it is by following correctly the distribution 
of the nerves you may tit yourself to make a correct diagnosis. 

In general the diseases which occur from lesions in this upper cervical re- 
gion are such troubles as toriicollis, troubles with the phrenic nerve — hiccough, 
neuralgia, and troubles of that kind. Of course the osteopath finds trouble 
with the phrenic nerve lower than the upper cervical group, generally arising 
from the 3rd, 4th and 5th cervical. When an osteopath meets such disease as 
crutch paralysis, writer's, violinist's or pianist's cramp he refers such cases to 
the plexus at some point, or to a lesion affecting it centrally. I remember a 
case of crutch paralysis which I treated. It was simply secondary from the 
use of a crutch, the crutch pressing upon the median nerve which comes from 
the inner and outer cords, thus affcting that nerve and consequently the thumb 
and first finger, which are supplied by it. Learn, then, to reason as to which 
plexus is affected. Having known this and how to treat it, your diagnosis 
will be correct, and you will be able to go understandingly about what you are 
trying to reajh. 

Hilton considers diseases of the upper cervical vertebage among the most 
serious which may affect the spme. I quote fromhim as follows : "No cases of 
disease of the spine are so immediately dangerous to life as th)se of the upper 
part of the cervical region, especially if situated between the first and second 
cervical vertebrae." The reason of this is the close proximity of the bones to 
the spinal cord. There is danger of rupture of the ligaments about the odon- 
toid process of the axis, and in case this is ruptured or worn away by disease, 
the medulla may be impinged upon, thus affecting the centers located there, es- 
pecially the center of respiration, and so cause death. He instances a case 
which I have thought would be useful to you. He had a case of a lady who 
was affected thus : She had pains upon the left side of her head at the back, 
pains behind the ear, and over the clavicle and shoulder, pain and muscu- 
lar paralysis of the left arm and deeper pain in the neck, which became appar- 
ent by pressure of the head straight down upon the spine and rotation of the 
parts there. He found that about the 1st, 2nd and 3rd cervical vertebra^ there 
was some tenderness slightly more marked on the left than on the right. Ho 
anticipated, that there was a history of some accident, but could find none, as 
the lady knew of no accident that had occurred. Her general health was very 
much affected ; she was unable to work ; for she had very sleepless nights, and 
her nervous system was yery much affected in general. He diagnosed this 
case, of course, from the tenderness in the cervical region : ho diagnosed it as 
a disease affecting the second cervical nerve, hence the pain is in the back of 
the head; he diagnosed it as affecting the 3rd, hence its distribution, also as 
affecting those parts supplied by the nerves which go to make up the bnuhinl 
plexus. 



19 

I simply brin^ this out to demonstrate the need of accuracy in diagnosis^ 
the need of reasoning closely along the lines of distribution of the nerves. In 
this case Hilton found that the urine was affected, that it was ammoniacal, and 
a less skillful physician would have treated the case for bladder trouble, as in- 
deed often occurs. The point I wish to make is, that the osteopath must not 
be carried astray by general symptoms. So where you find foul nrine, pain in 
the bladder, and things of that kind you may be led astray ; you surely will be 
if you are not one who knows his business. It is the dictum of one of the 
old schools, I do not know which, to ''Watch the symptoms carefully and treat 
them as they arise." And that has seemed to be the practice followed, But 
it does not need much reasoning to show yon that should an osteopath adopt 
such a course, he would rapidly become a failure in his chosen profession. 
There was a case here some time ago — a young man from Springfield, 111., 
came here with one leg shorter than the other. He nsed crutches 5 he had a 
severe pain on one side of the knee of the affected limb. That man had trav- 
eled extensively seeking help. He had been massaged and treated in almost 
every conceivable way; had lived in the hospitals for months. But one day he 
said to the ph^'sician m charge, "How does it happen that that leg is shorter? 
What is the trouble with that knee?" "Well," he said, "The bones may be 
separated and the tibia may have been pushed up, thus shortening that limb." 
If I remember correctly that case was cured practically in one treatment. I do 
not say this to illustrate our quick cures. The treatment was sufficient be- 
cause the muscles had been massaged, and were softened and ready to be work- 
ed upon. The hip was set. I became acquainted with the young man later. 
I realized what it was to have the deformity cured. He had been treated for 
years for the knee, but the trouble was in the hip. This is almost a threadbare 
illustration of what osteopathy does, but it illustrates my point here perfectly. 
If you follow up the symptoms and treat them as they arise, you will land in 
obscurity. I do not wish to criticise any system of medicine, but from our 
standpoint it will not do for an Osteopath to work in that way. If he does, 
he is a poor osteopath and does not understand what he is trying to do, and 
simply makes what the "Old Doctor" calls an "engine wdper". He goes after 
the seat of pain, and not the seat of the trouble, and simply becomes a masseur, 
and in his case the criticism could justly be made and that is some times claim- 
ed — that osteopathy is nothing but massage. 

Dr. Hildreth brought out this same point some time ago. He mentioned 
two things that made up the success of the osteopath. The first was in not be- 
ing too rough in our treatment, but the erne I want to call your attention espec- 
ially to was that osteopathy makes correct diagnoses. It goes back to the or- 
iginal cause, and does not depend upon symptoms merely. 

I wish to call your attention to the following point: That pain upon the 
surface of the body, not accompanied by any rise in temperature, indicates a 
distant origin of the trouble, and that trouble is usually in the spine. 



20 

Hilton says that if this local pain be upon the cutaneous surface then it 
will indicate spinal disease in every case. I have had a drawing put here 
showing "a" and "b," the distribution respectively of the 6th and 7th dorsal 
nerves. They meet over the pit of the stomach in the skin, and will refer a 
pain to that point. The patient thinks the trouble is there ; his trouble is in- 
variably at the spine. He, of course, will want you to treat the affected spot. 
There is a case on record of pain in the pubes and over the lower part of the 
abdomen ; the physician finding the trouble in the lower part of the spine, it 
being associated with paralysis of the lower limbs, decided it was spinal trouble 
and rubbed an ointment on the spine. The patient thinking the symptoms 
should be treated, rubbed the ointment over the lower part of the abdomen, 
being paid for his interference by a great deal of smarting. He wanted to 
treat the seat of the pain instead of the seat of the lesion. It is true that these 
pains are not mere happen so's. The^^ depend upon a close connection, as in 
this case, of the nerves ; this close connection may be either through the spinal 
nerves or it mav be through the sympathetic system. You may have a pain at 
a part, which you may trace up through a nerve, back up through the cord to 
the brain or center, down another nerve to the original cause ; so that an origi- 
nal cause may act along a nerve through a center and down through another 
nerve. 8o that the seat of the pain is not the seat of the lesion. If such a 
patient comes to you, do not become a masseur; do not treat the seat of his 
pain, but treat the seat of the lesion causing the trouble, and convert him by 
showing him true osteopathy. 

A peculiar phenomenon is often witnessed. You may come across a case 
in which one part of the body is more sensitive than another ; you may have 
paralysis, both muscular and sensory, below an injured part, with very acute 
hyperesthesia above. The explanation which has been given in such a case is 
two-fold. In the first place, take such a case as a fracture of the spine; of 
course the parts about the site of the injury are the seat of the inflammation : 
after the fracture the parts are engorged with blood, there are exudations, both 
fluid and cellular, about the parts, which may press upon the origins of the 
nerves just above the seat of the fracture and may irritate for a considerable 
distance up in the spine, thus causing considerable sensation above. Below 
the nerves have been injured by the trauma to the cord. The other explana- 
tion is chiefly the same, except that in it the origin of the spinal nerves is tak- 
en into consideration ; as you go further down the spinal column you will find 
that the roots run more and more obliquely in the canal, until Uually the lower 
ones run an inch and a half or an inch and three-quarters before emerging. 
And of course when the impingement is upon the origin of those nerves, the 
pain will be at their distribution upon the muscles and the surface of the body. 
I had a case similar to this — a man who is still in town for treatment. Ho has 
paralysis of the lower limbs, almost complete lack of muscular ability and also 



21 

almost complete lack of sensibility in the lower limbs. The lesion appears to 
be in the lower part of the spine. I say "appears to be," because there is 
another place higher up in the spine which may be the cause. But taking it 
as the lower one, he has a terrible itching and smarting along the spine ; upon 
treatment, however, he readily recovers from these symptoms Now, the ex- 
planation may be similar to that given, and it may partake of the reasoning 
that I gave you the other day concerning osteopathic matters. That is, that 
there is too much life above, and there is too little life below ; something has 
interferred to cut off nerve life and blood flow below, while that above is sup- 
plied with its full quota already and does not need that which is misdirected 
to it, thus there is irritation to the parts above and the resulting symptoms. 
What the osteopath does is simply, as was indicated before, to try to restore 
the equilibrium of nerve and blood forces to the lower parts of the body which 
are suffering, and then to the parts which are impigned upon above. To do 
this he simply goes back to the parts affected. 

Q. In the event of peripheral trouble, sensation, would you also find the 
sensation at the origin? 

A. Not necessarily. You might not have any sensation there. Other- 
wise, the patient would have himself perhaps discovered it. You may not 
have a sore spot at ail ; it may be such a lesion as spreading of the spines or 
approximation ol the spines, not necessarily any tenderness at the central, at 
the lesion. 

Q. Are there no exceptions to the rule that where there is pain on the 
surface, accompanied with rise of temperature, the trouble is of spinal origin ? 

A. I took Hilton as the authority there, and he gives this example. It 
is jast as invariable as in the case of inflammation, in which the principal sign 
is rise of temperature, you may have the swelling and the pam without the in- 
flammation, but if you have these two and heat also it is a sign of inflamma- 
tion. He makes a parallel and says it is just as invariable that if there is 
pain upon the surface of the body, accompanied by rise in temperature, the 
cause is of spinal origin ; he does not make any exception. 

Q. I understood you to say that the 5th nerve was reached through the 
sympathetic ? 

A. The 5th cranial is reached through the superior cervical ganglion. 
We get results which justify us in saying this ; any operator will tell you that 
he gets results from the superior cervical that influence the 5th nerve. Of 
course he does it by sympathetic connection, which I will explain at another 
time. 

Q. In the case of that man with the pain on the inside of the knee, sup- 
pose that he should have had localized trouble at the knee, would you have 
recognized the condition by the lesion in the spine? 

A. Yes, partly, and you would have to go into the historv of the case. 



22 

You would have to go back to your centres and determine what was the trouble. 

The first thing would be to go to the spine and thoroughly examine ; if you 
find a lesion there, the probabilities are it is of spinal origin. You should by 
all means whenever you have such a case, or any case, go back to the center of 
the nerve supply, and you may find the lesion there, above or below the ceater, 
or you may not have a distinguishable lesion. 

Q. In the event of a severe gastritis would there be a soreness in the 
spinal region ? 

A. Very likely there would be, and in that case your soreness and con- 
gestion of the muscles would be what I have explained as secondary. 

Q. Which would be secondary? 

A. The congestion of the muscles along the spine. In a case of severe 
gastritis you would very likely find sore spots along the spine. The explana- 
tion being that the nerve influence from the disturbed stomach travels along 
the sympathetic branches of the solar plexus back to the spinal connection of 
those nerves, and then passed through to the peripheral termination of the 
spinal nerves in the muscles of the back. 

Q. Is it true that you can designate which organ of the body is m trouble 
by finding the tenderness in certain spots in the spine ? 

A. Yes, in general that is true. I thought I brought that point out in 
my last lecture. The sore spots may be due to either peripheral or central 
trouble, and by determining whether they are primary or secondary you may 
locate the trouble by reasoning from the center to the periphery. 



LECTUEE VI. 



At the last lecture I called your attention to the further significance of 
the clicking in the neck, stating that it frequently meant a lack of lubrication 
secreted in the synovial membranes. I began to take up the general effects 
of lesions of plexuses along the spine, taking up the first group, the upj>er 
four cervical nerves. I called your attention to the fact that pain must be 
referred to the origin of the nerve supplying a part, instancing the anterior 
pendulous portion of the ear and the posterior portion of the ear as being 
supplied by the second cervical nerve, versus pain in the other parts of the 
ear indicating lesion in the fifth cranial nerve. Hilton considers disease of 
the upper cervical portion of tlu^ spine among those most dangerous to life. 
The operator must not confuse symptoms with causes. He must not take, 
for instance, some symtom which may be prominent, thinking it to be one of 
the first causes. If there is pain upon the surface of the body not accom- 
panied by any rise in temperature, it indicates disease of the spinal region. 
A peculiar phenomenon often witnessed is that there is x>ivralysis of sensation. 



23 

or motion, or both, at a point below a spinal injury, while there is acute 
hyperesthesia just above. The explanation was given that it was owing in 
part to the obliquity of the course of the spinal nerves, in part to the en- 
gorgement of the parts and the exudations, fluid and cellular, which takes 
place around a serous lesion of the spinal cord. To-day I wish to pursue 
this line of thought somewhat further, hoping to finish it in this lecture. That 
is, this general point of the significance of general symptoms to the Osteo- 
path. 

1. Further consideration of Osteopathic significance of points found in 
diagnosis. 

The lower four cervical nerves and the brachial plexus constitute what 
is known as the. second group of nerves. The brachial plexus sends short 
branches to the shoulder and upper intercostal muscles, and long branches to 
the arms. In general the effects which may follow lesions to the second 
group of nerves are paralysis, spasms and neuralgias. Such troubles the 
operator must learn to refer back to the center; that is, to the origin of the 
plexus along the spine. Should you have palsy of the hand, or edema which 
is neurotic in origin, such cases you must refer to trouble in the brachial 
plexus. Of course this is speaking of these nerves as members of the cere- 
bro- spinal system. Please remember, also, that the first group of nerves is 
connected with the upper cervical ganglion of the sympathetic, and that the 
second group of nerves is connected with the second and third ganglia of the 
symiDathetic, and that in case the lesion be severe enough to affect sympathe- 
tic life, you may in lesions in this region have far-reaching disturbances. Ee- 
member also that from the third, fourth and fifth cervical nerves arises the 
phrenic nerve, and that injury here may cause diaphragmatic trouble, hic- 
coughs for instance, which we treat in that region. 

The third group of nerves is composed of the twelve dorsal nerves. Of 
these the first six are connected with the first six dorsal ganglia of the sym- 
pathetic, and the last six but one are connected with the remaining six dor- 
sal ganglia of the sympathetic. In their capacity as spinal nerves the mem- 
bers of this third group are subject, usually, to merely sensory affections. 
Thus you will frequently come across in your practice, cases of intercostal 
neuralgia. This the Osteopath diagnosis, and is usually correct, as a pres- 
sure upon the nerves, caused by crowding together of the ribs. Later, when 
we come to take up the consideration of the thorax, you will find that we 
make prominent the point that the ribs are dropped together frequently or 
are drawn together, and you will learn to reason thus, as in the case of in- 
tercostal neuralgia, from the Osteopathic point of view. Lesions here may 
also cause herpes zozter, commonly called shingles, a nervous affection ac- 
companied by eruptions upon the skin. From their sympathetic connections 
this group of nerves may be associated with troubles of the pleura or lungs, 



24 

and with sympathetic troubles of the viscera, as you know the splanchnic 
nerves run from the sympathetic connections of the dorsal nerves to the vari- 
ous viscera of the body. 

The fourth group of nerves is composed of the five lumbar nerves, the 
upper four of these nerves, with the twelfth dorsal are connected with the five 
lumbar ganglia of the sympathetic. Diseases which may affect these nerves 
as members of the cerebro spinal system are mainly neuralgic. Of course 
you may have paralysis or spasms, but you are not so liable to have them as 
in lesions of the nerves of the cervical or sacral region. Sympathetic troubles 
of course would occur according to the centers with which these nerves are 
connected. 

The fifth group, finally, is that composed of the five sacral nerves. These 
five sacral nerves, with the fifth lumbar, are connected with the five sacral 
ganglia of the sympathetic. Lesions affecting these spinal nerves are such as 
affect the cervical nerves in general, that- is, paralysis, spasms, and neu- 
ralgias, which may vary greatly in character. You may have tonic or clonic 
spasms of the lower limbs; you may have neuralgia, such as sciatica; or you 
may have paralysis of the lower limbs. Sympathetically, of course, you 
would refer to such troubles as are indicated in the outline of centers given. 

I have thus taken up the grouping of the nerves along the spine. Of 
course it has been very general. The purpose has been to give you a general 
view of regions affected, and to give you a general idea of how the Osteopath 
looks at disease; that is, he reasons from periphery back to center. My treat- 
ment of the subject has necessarily been general, leaving aside a more particu- 
lar view until such time as we shall take up these different effections which 
we meet, more in detail. I may in these last few lectures have been a trifle 
obscure; I find it a rather difficult subject to elaborate and, being so general, 
it may have been indefinite. Still I trust it may have fulfilled its object, 
which was, briefly, as follows: In the first place, to indicate to you the ne- 
cessity of keeping separate in your mind the cerebro -spinal system and the 
sympathetic system. Remember that you cannot separate these entirely, but 
look for symptoms from the one and look for symptoms from the other, one 
is a cerebro -spinal view and the other a sympathetic. You do not really find 
them so separated in your practice. Second, to impress you with the im- 
portance of diagnosis based according to the centers aftected. Third, to teach 
you not to confound incidentals with essentials; not to mix mere symptoms 
with causes of disease. I thought I could thus indicate to you, that Osteo- 
pathic point of view, that Ost>t^opathic habit of mind in looking at disease. 

Hilton states that as a rule pain in disease of tlie lower cervical, dorsal 
and lumbar regions is indicated by pains symmetrically upon the surface of 
the body. That in the upper cervical region being not indicated syminetiical- 
ly by pain upon the surface of the body. The original cause for such pains 



2o 

we would look for, of course, in a central lesion. If the trouble be bilateral, 
located on each side of the body, we would look for a central cause, or per- 
haps the cause may be bi-lateral. I instanced a case at the last lecture of 
pain over the skin at the pit of the stomach, being referr.ed back along the 
course of the nerves to the sixth and seventh dorsal vertebrse. Hilton in- 
stances a case in which a boy had severe pain there; he went about stooping, 
holding his hands over that region. Upon lying down the pain disappeared 
to some extent. His diagnosis of that case was that there was trouble at the 
sixth and seventh vertebrae, and he found disease there of such nature that it 
exerted pressure upon the sixth and seventh nerves upon both sides. An- 
other case similar, was more complicated in that it lead to vomiting. Almost 
any physician would have diagnosed such a case as stomach trouble, no 
doubt, Hilton, however, upon examining the tongue found no indications of 
stomach trouble, and diagnosis that case also as disease of the sixth and sev- 
enth vertebra, directed treatment to those points, and was successful in cur- 
ing the case. Sometimes in such diseases we find a pinching feeling about 
the body, a feeling as if the body were girdled. Xow, as to the reason why 
these pains are symmetrical in these parts of the body I have already indi- 
cated. But why they do not occur so above is simply this: The difference 
in the nature of the vertebrae. Thus, below the second cervical, the vertebrse 
articulate with each other by their bodies and articular processes, but above 
that point it is different; the atlas articulating with the occiput by just two 
points, and one might be affected without communicating with the other. 
The articulation of the atlas with the axis is by just three points; the odon- 
toid process articulates with the anterior arch of the atlas, and the bodies by 
the articular surfaces. Xow, any one of these may be affected, and it is the 
rule that one of these is affected without communicating the disease to the 
other. Thus you may have a symmetrical distribution of the pain. A further 
point of importance is that if a certain organ is affected the impulse may be 
transmitted sympathetically from it and reflected to another organ, and that 
always in such a case it is . carried to that organ connected most closely by 
nerve strands to the organ first affected. Byron Eobinson says that ganglia 
of the sympathetic, especially the cervical ganglia and the abdominal brain, 
are points of reorganization of impulses sent to them, and of redistribution of 
these reorganized influences or impulses, which are sent to various viscera, in 
general, to those most closely connected, those which are furnished with the 
greatest number of nerve filaments. I quote from him as follows: ''It is a 
principle in physiology that when a peripheral irritation is sent to the ab- 
dominal brain, the reorganized forces will be emitted along the lines of least 
resistance, so that the organ which is supplied with the greatest number of 
nerve strands will suffer the most.- ' He cites here a prominent instance of 
uterine tumor affecting the heart, and in this way, that the influence of the 



26 

uterine tumor upon the hypogastric plexus was reflected back through the 
solar plexus, where it was reorganized and sent out along the splachnics to 
the superior cervical ganglion and the next two below it, and was then sent 
out along the three cardiac branches to the heart, thus causing an irregularity 
of the heart, leading finally to heart disease. This point is of great importance 
to the Osteopath. You will find it very common in your practice to find a 
case of uterine trouble resulting in headache. Thoroughly apply any of the 
ordinary methods of treatment to the headache, and they will certainly be un- 
successful. You must learn to diagnose with these things in mind, and to 
reason according to the connection of these parts through the sympathetic 
system. Now, in the instance given, the impulse might have been sent dif- 
ferently. It might have passed from the hypogastric plexus to the solar 
plexus, being there reorganized and then sent out to other viscera throughout 
the body, as is frequently the case. Or it might have run up through the 
sympathetic cord, reaching the medulla, then affecting the vagi iierves, re- 
sulting in stomach trouble. Another illustration I take from him. He calls 
to mind the fact that the kidneys, ovaries, uterus and fallopian tubes of the 
female are developed from the Wolffian bodies in the embryo. They are thus 
closely connected in nerve and blood supply, and it is a fact that uterine 
trouble results often in kidney trouble, and kidney trouble may very readily 
result in uterine trouble. In such a case it is difficult to diagnose the case 
according to the symptoms, and to determine what must be the original cause. 
These secondary symptoms are frequently quite prominent, and treatment 
directed to them will not necessarily have any effect upon the original trouble. 

II. Landmarks concerning the scapula. Holden instances the following 
points concerning the scapula. First, that it covers the ribs from the second 
to the seventh inclusive on either side; that its superior angle is beneath the 
trapezius muscle; that its inferior angle is beneath the latissimus dorsi mus- 
cle; this latissimus dorsi binds the posterior edge of the scapula closely down 
against the posterior chest- wall in a strong person. In case of consumptives 
the scapula is allowed to project outward at its lower angles, and this gives 
the peculiar appearance which is called, ^'scapula? alat?e." A horizontal line 
from the sixth dorsal spine to the inferior angle of the scapula outlines tlie 
superior margin of the latissimus dorsi muscle. A line drawn from the root 
of the spine of the scapula down to the twelfth dorsal spine outlines the in- 
ferior burder of the trapezius muscle. In examining a back it is convenient 
to have the patient sit leaning forward Avith the hands hanging between the 
thighs; this brings the superior angle of the scapula, down about the third in- 
tercostal space, about on a level with the fissure between the upper and Ionnov 
lobes of the lung. 

III. How TO Treat a Spine: — Having Ictirnod how to exaniiiio a spine. 
having learned also the significance of points one finds along the spine in bis 



examination, the next question naturally is, how to treat these points when 
oDserved. I am indebted to Dr. Eastman for calling my attention to the fact 
that often these noises which we may find in treating along the spine are 
of peculiar significance in this way: That he says he has often pushed ri^s 
back into place which had been slipped, simply by this pushing motion along 
the spine. In our treatment of a spine there are *.wo points which we may take 
into consideration ; two objects which we may have in view. In the first place, 
we may wish to treat the spine per se, treat the spine itself. In the second 
place, we may wish to reach, by treating the centers along the spine, the viscera 
to which these nerves run. It is not always possible to diassociate these in 
your practice. Indeed, this is more a separation of convenience. I have di- 
vided these points thus simply for convenience in the consideration of them. 
You will of course, in practice not be able to separate the results upon the 
spine itself from the result which you will get upon the centers when working 
along the spine, but the Osteopathy of it is the same, and I trust will be made 
clear to you by this division. 

Now, when you are treating a patient, one very good way to treat the 
spine, to get everything relaxed, is simply to lay the patient on his face. The 
patient usually thinks he is relaxed when he may not be. I think those of you 
who are familiar with Delsarte methods will agree with me. Your first care is 
to see that the patient has become fully relaxed. Now, we wish to learn how it 
is that we may affect the central distribution of the sympathetic nerve. I spoke 
to you the other day of the gray rami communicantes extending from the gan- 
gha of the sympathetic back to the spinal column, supplying the blood vessels 
of the dura mater of the vertebrae, and the ligaments. Thus, if you wish to 
treat the spine itself, wish to strengthen it, of course you must necessarily di- 
rect your treatment to reaching these vaso motor nerves in order to relax and 
allow sufficient nutriment to be sent to these parts. In order to do this you 
must always first loosen all the contractions of the muscles along the spine. 
Very frequently you will find that the muscles are contracted unevenly and slip 
under your fingers. That is a test; a muscle may be hard, as it naturally is, 
from exercise; then the hardness is homogenous. The first point, then, is to 
loosen up the muscles, and in doing this it is well to bear in mind that you 
must work against the course of the muscle fibres, the deeper ones especially. 
It is perhaps easier in that way to get a relaxed effect, and your idea should 
be to work in such a way as not to hurt the patient. You may treat so hard 
and so roughly as to damage. The motions that I may make, or the faces that 
Dr. Hildreth makes when he is treating a patient, are not any indication of 
the amount of force used, that is a habit, and the thing you should guard 
against is too rough treatment, as you may injure delicate parts. In seeking 
to relax a nerve you may harden it, and thus cause the muscle to sfirink. You 
should not manipulate with the tips of the fingers, you should turn the fingers 



28 

so that the cushioD of the finger does the work, and in that way thoroughly re- 
lax all the congested or contracted muscles alons^ the spine? What if you do 
not have any contracted muscles there? That, of course is the condition in 
many cases. It is our work in such a case where the muscles are flabby and 
there is a lack of tone, to stimlate all along the spine, and thus to tone up the 
parts. Do not be afraid of being thorough in this matter. You must relax 
all the muscles there from the occiput to the coccyx, as they may any of them 
produce sympathetic troubles which may be reflected over a considerable por- 
tion of the body. 

There is a certain amount of hair splitting done over the terms of desensi- 
tization and stimulation. Their significance I will take up later, but always bear 
in mind that your first point must be to relax contracted muscles if you find 
them; if you do not, your work should be directed towards reaching the dseper 
structures mechanically and securing an equal distribution of nerve force. If 
there are concontractions, no matter what your final treatment is to be, you 
must get rid of those contractions first. While the patient is upon his face there 
is an important effect which we get upon the spine itself. Of course we cannot 
separate this really in our prctice 5 that is, the work along the spine has its effect 
upon the body according to the centers reached. Suppose I wish to reach the 
center going to supply the nutrition of these parts, I spring the spines up, 
using the arm as a lever, and by so doing you can exert a great deal of force. 
Drawing up the arm raises the ribs, and at the same time, by springing the 
spine up, I can get a considerable force all along the spine. This is one way. 
Another way is to draw the limbs up; you will find this a very convenient 
method, this of course will bow the back and make prominent the spines, then 
you can readily reach under, and in that way you can spring the spine or any 
part of it ; and it is always advisable for you to stretch the spine in that way 
rather than to attempt to stretch the patient by pulling the neck ; that is a ten- 
sile strain upon the spinal column, and of course it resists more than it does 
a lateral force. You will find this useful in your practice. There is another 
method which we frequently use, getting one elbow down against the upper 
edge of the pelvis, and the other against the prominent part of the shoulder, 
and separating them, also reacing over the spines of the vertebre, you relax 
all along the spine. When you have done this upon one side, repeat it on the 
other. And why"? Because when you spring the spine in this way all along, 
you have stretched the ligaments upon that side, but you have not stretched 
the others. You can readily see that as I spring these spines the effect must 
be to stretch the ligaments on the convex side, and to relax the ligaments up- 
on the concave side of the curve. So you must turn the patient over, treat the 
other side, i)roviding you wish to reach the ligaments upon both sides of the 
spine. You may treat the muscles alone in this way. When you have that 
object in view, which depends upon your case, usually you must exert consid- 



29 

erable force, but do not dig. Do not use the end of your fino-er. You can de- 
velop strength so ttiat you can keep the fingers flat and work with the cushion 
of the fingers against the muscle, and in this way you can get a very good ef- 
fect upon the muscles themselves. Do not be afraid, but keep at it until they 
are relaxed; do not treat too hard or you may stimulate, and they will con- 
tract more, but by deep work along the spine 3^ou may have a soothing effect 
upon those nerves and thus cause them to relax. What has been the object 
of this work? Simply this, that by relaxation of the contracted muscles or 
by stimulation of those weak, flabby muscles, you have succeeded in drawing 
new life to that spinal column, and in that way have made your first step to- 
wards reinstating the strengh of that debilitated spinal column. 

Q. Is a simple manipulation there enoLigh to relax the contracted mus- 
cle? 

A. Yes, simple manipulation is enough if rightly applied. 

Q. Is a dislocation of a vertebra liable to cause giddmess? 

A. It may very readily. It may act in such a way as to shut off the 
blood supply to the brain. 

Q. More likely the cervical vertebrae? 

Y. Yes, more likely in the cervical region. Or it might act in such a 
way as to cause retention of the blood in the head and result in dizziness. 

Q. Did Dr. Eastman say that a rib displaced was the cause of a noise 
along the spine ? 

A. As-he pushed the rib, and as it went back into place it made the 
noise. 

Q. If you had a patient wtio was unable to raise his hands above 
the level of the shoulder, and there was pain at the insertion of the 
deltoid muscle and also over the shoulders, where would you look for the 
trouble ? 

A. I would look for the trouble in the brachial plexus, the origin of the 
circumflex nerve, supplying the deltoid muscle. 



LECTURE VII. 



At the last lecture I took up further consideration of the Osteopathic 
significance of points found in diagnosis. I called your attention to the trou- 
bles which may, in general, effect the lower cervical group of nerves; those 
which affect the brachial plexus, for instance, being chiefly spasms, neural- 
gias and paralysis. Also, I called your attention to the connection between 
those nerves and the sympathetic ganglia; also the connection of the third 
group, the dorsal nerves, except the twelfth, with the sympathetic dorsal 
ganglia; the diseases of this group being chiefly sensory. I then spoke of 



30 

the connection of the fourth group, the upper four lumbar nerves and the last 
dorsal, being connected with the five lumbar ganglia of the sympathetic; the 
diseases of the fourth group being chiefly neuralgias, and not spasms or par- 
alysis, although you might find them in that group. Spasms and paralysis, 
as well as neuralgia, being more commonly found in the fifth groui^; the five 
sacral nerves and the last lumbar being connected with the sacral sympathe- 
tic ganglia. I also traced in general the connection between these plexuses 
and diseases which might originate there, stating that my object in the last 
two lectures had been to aid you to keep separate the cerebro- spinal and 
sympathetic systems, to diagnose diseases according to centers, and to teach 
you to separate non-essentials from essentials. I instanced this rule of nerve 
force, that it is emitted along the path of least resistance, and that, sympathe- 
tically, the organ most closely connected by nerve- strands with the organ af- 
fected is most apt to suffer; that, in the sending of such impulses along the 
paths of the sympathetic system, certain centers, such as the abdominal 
brain, are centers for reorganization of those impulses, so that, being re- 
flected to these centers, they are sent out reorganized. I then drew some il- 
lustrations to account for phenomona witnessed according to this law. I then 
called your attention to landmarks concerning the scapula, and to treatment 
of the spine. That being the question you naturally ask after having learned 
to examine the spine. The general points brought out being that there is a 
treatment upon the spine itself, and a treatment of the spine for further reach- 
ing effects, chiefly through the sympathetics, upon the internal viscera. And 
I showed you, by laying the patient upon his face and upon his side, what 
was the technique of manipulation that we employ. I shall, in the latter part 
of this lecture continue that subject. I have tnought that for the first part 
of my lecture to-day it would be helpful to us to consider the Osteopathic 
theory of work upon centers. 

I. How does the Osteopath by external manipulation upon the surface 
of the body affect internal nerve life? How can he reach centers in the spine, 
or nerve centers in any part of the body? What does the Osteopath mean 
when he says that he stimulates, or desensitizes, or inhibits nerve actionf 
Those are great questions. It is needless for me to say to you that they lie 
at the basis of our science. It is not a question as to fact. The facts are al- 
ready iDroven beyond a doubt, but it is a question of finding a rational 
scientific explanation of facts; of establishing theories which lie back of our 
work. Osteopaths have different views concerning these matters. They 
answer these questions differently. I called upon the different operators in 
the building to give me a synopsis of what their views were. There were 
some who said they were not able to explain satisfactorily some of these 
things, and there was also some disagreement in their answers. 1 simply 
wish to add my little mite, not at all supposing that it will solve {ho i]ues- 



31 

tion for all time. There are, however, certain facts in relation to these ques- 
tions which I think it will be profitable to call to your attention, and I will 
also make some reference to the answers which I have received from the old 
operators whose experience has been wider than mine. Eemember, it is not 
a question of ' 'Do you do this? Do you accomplish such results? ' ' but 
granted that the results are accomplished, which is true, ' 'how do you accom- 
plish them?" In approaching this question we must clear away all misap- 
prehension as to definition. Do we, when we say "desensitization." etc., 
mean the same as the physiologists mean when they say de sensitization, 
stimulation, etc., and can we, in the generally accepted view, have such an 
effect upon the nerve as to desensitize or stimulate them? For this reason I 
will first define these points according to the physiological view, and then ac- 
cording to the osteopathic view. The physiologist uses these terms in two 
senses. First, in the usual normal sense; a normal impulse sent from a cen- 
ter along a nerve or from a periphery along the nerve, resulting in function. 
For instance, an impulse is sent from the brain along a nerve causing the 
contraction of a muscle. Again, a sensation of pain comes from the periphery 
to the center, which thus receives it, and there is a sense of pain. In this 
case there was a stimulation of a sensory nerve by the agency producing the 
pain, no matter what that agency was. For instance again, the normal and 
continuous inhibition of cardiac action through the vagi by the impulse sent 
from the brain, ^ow, that is the normal and usual sense in which these 
terms are used. The second sense in which these terms are used by 
physiologists is irritation of a nerve, and thus its stimulation or inhibition of 
function by physical agencies, as heat, cold, electric current, application of 
pressure or tapping, or the application of chemicals. That is Vhat-he usually 
means when he says he has acted upon a nerve, has experimentally treated a 
nerve. He may, for instance, apply a caustic and elicit a sensation of pain, 
and state that he has stimulated the nerve. He may, for instance again, ap- 
ply an electric current, stimulate the nerve, and cause muscular contractions. 
Or, finally, he may by pressure or tapping upon the nerve, carried to the 
point of exhaustion, secure the result of paralysis, that is, inhibition of the 
nerve action, resulting in the loss of sense, or of motion, or of both. He 
then says that he has desensitized the nerve. He thus by the use of physical 
agencies produces results similar to the normal, for instance, the contraction 
of muscle, and he reasons that the impressions aroused by such agencies are 
similar to normal; he has really stimulated, or inhibited, or desensitized. 
For instance, he by some agency, the use of an electric current, so stimu- 
lates the periphery of the sciatic nerve that he gets a vaso- motor effect in 
the nerve. He reasons that, as he has stimulated the nerve fibers in a man- 
ner similar to normal, therefore there are sympathetic ^aso-motor fibers in 
the sciatic nerve. This was the actual method employed in determining that 



32 

vaso motor fibers were contained in the sciatic nerve, and this was accepted 
by the authorities. I believe that I have thus correctly represented the 
views of the physiologists in the definition of these terms. 

Second: How does the Osteopath define these terms! What does he 
mean when he uses them*? He uses them, of course, in the normal, 
physiological sense, which we will leave aside. He also uses them in an- 
other sense, which for the present we will leave aside also. But the question 
to-day is, does he by a physical agency, that is, by manipulation, by pres- 
sure, by tapping, and stretching, all of which he uses in effecting nerve fila- 
ments or nerve centers, produce a result similar to normal, and he be, with 
the physiologist, allowed to reason that therefore the impulse which he has 
aroused by the use of such physical agencies is similar to the normal? A 
pressure on the phrenic nerve controls the spasm of hiccoughs. The result of 
the use of such physical agency is similar to normal, hence the impulse must 
have been similar to normal. Again, by rubbing the neck in the region of 
the superior cervical ganglion, he stops bleeding from the nose, and produces 
an effect similar to normal, hence the vaso motor influence generated by ir- 
ritation in that region must be similar to normal. He says he desensitized 
phrenic or stimulated the superior cervical ganglion. We must allow him 
equally with the physiologist to say that he has stimulated, or inhibited, or 
desensitized the nerve in question. Now, the question at once arises, what 
was the manner of the application of those physical agencies? Does the 
physiologist, as well as the Osteopath apply these agencies externally? Of 
course if there is a difference in application, then our reasoning would not 
hold good. But my reply here is, yes, he applies them externally, though 
not always. Still, if he, the physiologist, does it only sometimes, and ob- 
tains results which justify him in saying that he has really desensitized, stim- 
ulated or inhibited, the case is proven for the Osteopath, even though the 
latter works externally always, providing only that the Osteopath obtains as 
wide a range of results as does the physiologist, who works both externally 
and upon the exposed nerve or center. That the Osteopath, by his means 
obtains results in every part of the body is shown by cases upon record. 

I wish to quote from text books to show that the physiologist does work 
externally upon the body to produce his results. In the first place I quote 
from Dr. Lombard, Professor of Physiology in the University of ^Michigan, 
in Howell's American Text Book. ^'If pressure be brought to bear upon the 
ulnar nerve where it comes across the elbow, the region supplied by the 
nerve becomes numb." Now, in the context he explains that everyone has 
occasion to demonstrate this upon himself, evidently implying that externnl 
pressure was used. Dr. W. T. Porter, M. D., Assistant Professor of 
Physiology in Harvard Medical School, in the same text book states as fol 
lows: "The reflex action of the symi)athetic nei-vc^ upon tht^ litnirt is woll 



83 

shown by the experiment of F. Goltz in a medium sized frog, the percardium 
was exposed by carefully cutting a small window in the chest wall. The 
pulsations of the heart could be seen through the thin pericardial membrane. 
Goltz now began to tap upon the abdomen at the rate of about 140 times a 
minute with the handle of a scalpel. The heart gradually slowed and at 
length stood still in diastole. Goltz now ceased the rain of little blows. The 
heart remained quiet for a time, and then began to beat again, at first slowly 
and then more rapidly. Some time after the experiment, the heart beat about 
five strokes in the minute faster than before the experiment was begun. The 
effect cannot be obtained after section of the vagi." 

I have thus quoted at length to show with exactness the manner of ex- 
perimentation and -the external application of this physical agency which was 
employed. Again, the physician in applying the electric current to a living 
patient for the purpose of diagnosis or treatment, applies the same externally. 
I quote from Dana: ^ ^Statical electricity is applied from fifteen to twenty 
minutes daily or tri-weekly. For general tonic or sedative effects, sparks are 
drawn from all parts of the body except the face; in paralysis or spasms of 
pain, sparks are applied to the effected area. In general electrization, 
whether galvanic or faradic, the indifferent electrode is placed on the sternum, 
feet or back, and the other pole is carried over the limbs, trunk, neck, and, 
if indicated, the head." In this course of the argument I wish to instance 
what I heard Dr. Eckley say once concerning the surgical method of treat- 
ing sciatica. He said that an incision was made through the gluteal mus- 
cles down to the nerve, laying it open to view; that a hook was then used, 
and the nerve stretched with a force of about forty pounds, that is, sufficient 
to raise the heel of the patient from the table, the patient lying on his face. 
That was the surgical method of stretching the nerve to relieve cases of 
sciatica. He also went on to say that the method used nowadays is that of 
flexing the thigh upon the thorax, thus giving a strong tension to the nerve, 
and that is the treatment used to-day by physicians for the cure of sciatica. 
You will see that that was external manipulation, that the application of the 
electrical current was external, the tapping upon the abdomen was external, 
and the pressure upon the ulnar nerve was external. I have simply en- 
deavored to show that the Osteopath in treating nerves and centers employs 
physical agencies externally. In one case the physiologist is allowed to say, 
and it is accepted by the authorities, that he has stimulated a nerve, stimu- 
lated nerve action by this means, and inhibited nerve action by this means, 
and my argument is, therefore, that in the same manner the Osteopath must 
be allowed to say that he has stimulated or inhibited nerve force, and that 
we therefore use these terms in the generally accepted manner. This is my 
view of the subject, and I believe that my conclusions are reasonable and 
fair. That from the results accomplished, means employed, and manner of 



34 

application of the physical agency by the physiologist and by the Osteopath, 
the latter is as much entitled as is the former to ths use of the terms stimula- 
tion, and inhibition in their generally accepted sense. 

I shall follow this subject further for a lecture or two. There are many 
points in relation to the work upon nerve centers which are obscure, and 
which I think I can with value attempt to illustrate before you. 

II. How TO Treat a Spine. (Continued.) — Whereas, the last time I 
gave you the treatment for the spine itself, to-day I will take up the con- 
sideration of treatment of the spine for distant effects. The point here is, 
that we may not only treat the spine, with the patient upon his face, for im- 
mediate effects to the spine, but we may treat to reach viscera through the 
sympathetic nervous system. Your first object is to relax all the structures 
as in the other case, for the reason that tension here in the muscles may af- 
fect a center, it may affect not only the center which relates to the spine it- 
self, but a center, for instance, the splachnics, controlling the stomach, or 
the kidneys, or the bladder, or some of the internal viscera. You will very 
commonly find sore spots along the spine. The indication is usually that 
they are the seat of lesions. We reason, then, according to the sore spots, 
or according to the contraction of the muscles, or according to the separation 
of the vertebrse, or whatever the lesion may be, to the centers of the sym- 
pathetic affected. If we know where the different centers are situated along 
the spine, and find a lesion at a certain point, we can reason what the result 
would be, or vice versa, by finding a certain disease manifest in the body we 
can trace back from the disease to the center, and expect to find a lesion at 
or near that center. For instance, suppose I had examined this gentleman 
and found that he had lung trouble, I would then, according to Osteopathic 
procedure, go back to the centers along the spine, and I would look from the 
second to the seventh dorsal for a lesion, and if I did not find a lesion, I 
would still stimulate in that region. I might here instance a case that I have 
treated, a case of congestion of the lungs associated with heart trouble, where 
there was great difficulty of breathing, considerable pain accompanied by 
pallor and general debility, and there was every indication that the lungs 
were affected. And by giving not more than a minute' s work in this region, 
from the second to the seventh dorsal on both sides; the patient sitting upon 
a stool, I, standing behind, raising the ribs and stimulating the centers, got a 
good effect. Sometimes in such a case you have to work quickly, and in 
some cases you will find that it will not do to have the patient lie down. If 
I should, for instance, be treating this gentleman for stomach trouble, hav- 
ing in my examination and in my conversation with him found that he was 
so afflicted, I would look for some lesion along the spine in the region of tlie 
splachnics, from the sixth dorsal down to the twelfth, especially the upper 
splachnics for the stomach, And in that event, how would I go ;ibo\it to 



35 

treat him? Simply by use of the points which I gave you in how to treat the 
spine. I would loosen the spine, and relieve any tension in the ligaments 
which I might find there. I would stimulate the muscles all along in this 
region, and work out any sore spots, and any contracted muscles. This con- 
tracture, or tightening of the muscles, I shall go into deeper in the course of 
a lecture or two. Thoroughly work along the spine, not too hard, using the 
flat of the fingers, which requires some little strength in the muscles of the 
forearm. You need not be afraid of the patient, you need not be afraid to 
apply your treatment thoroughly, but you should use your judgment as to 
how long a treatment you should give. It is yqtj hard to say anything as to 
the length of time of treatment; you will have to learn that for yourselves. 
Though in general a young Osteopath will treat a very long time, and an old 
operator will treat a much shorter time. If I should find that there was 
genital trouble or trouble with the pelvic viscera I should naturally look 
along the centers in the lumbo- sacral region, and I would very likely find a 
lesion at the fifth lumbar, where I would find a soreness. In that case he 
would relax all the parts; I would bring the legs up against me and get a 
close application of the hand to the affected spot. Then holding in the sacro- 
iliac articulation, and, by lifting up against it allowing the weight to hang 
down from that point, I spring the pelvis and bring pressure upon these liga- 
ments, first on one side and then on the other, relaxing all the structures 
around the fifth lumbar- preparatory to reducing any slip which may be 
found there. Suppose there was not a slip there but simply a sore spot, my 
object would be then to work out the sore spot and thoroughly relax all of 
the tension. I will take up the setting of the slip of the spine at another 
time. In the examination of a spine we may find a vertebrae lateral at any 
point. Suppose, for instance, that the twelfth dorsal is slipped laterally, to- 
ward the right, we would very probably find that the sore spot was on the 
right side, as the sore spots in the muscles are as a rule on the side to which 
the spine is slipped, though it may be on the other side. I would first treat 
here at the twelfth dorsal, loosening the muscles about that point. How do I 
know when I have done enough of that! In general, when you find a more 
relaxed condition there. Yet you cannot always at the first treatment relax 
all the muscles; you will find cases very stubborn. I have treated cases 
where the muscles would relax under treatment but would contract again im- 
mediately. It will depend upon the case, but work a reasonable length of 
time and relax all the parts if possible. After I have relaxed all the muscles 
upon the right side about the twelfth dorsal, I pursue the same course on the 
left side; then go deeper than the muscles and stretch the ligaments. What 
is the condition of those ligaments when the spine is slipped in this way? I 
have shown you in a previous lecture that they are probably all upon a ten- 
sion, some forward and some backward. What we seek to do is to spring 



36 

the spine up. By springing it you get the curve above and thus stretch the 
ligaments on this side; then turn the patient over and go through the same 
process upon the other side. Now, you will naturally want to know how 
soon to attemj)t to reduce this slip of the vertebra. Most young Osteopaths 
when they find a dislocation want to put it back into place at once. You can 
only do that in rare cases. In a recent dislocation, if it is not very serious 
and does not set up a great amount of inflammation, it may be reduced at 
once. In an old dislocation you will have to work a considerable time to re- 
lax all these parts, throw new blood and nerve force there to endow them 
with new vitality which they have been lacking, and you will have to learn 
by practice to work a sufficient length of time before attempting to set a 
vertebra. There are several methods of doing this. One of the best is to 
first exaggerate the condition. I would in this case have my patient upon a 
stool, the spine being tipped over toward the right, I bend the patient so as 
to exaggerate the condition, and thus bring tension upon the ligaments upon 
that s'de. I have before brought tension upon the other side and relaxed 
everything as far as possible, and by working the patient up and around, 
holding against the spine of the vertebra, I in that way slip it back into 
place. It does not always go back with a pop as nicely as could be, but you 
will perhaps have to pursue that method of treatment for a considerable 
length of time. But remember, please, that in setting a misplaced vertebra, 
in general the method is to exaggerate the condition, and that you then work 
in just the opposite way and throw the curve in the opposite direction. 

Q. I do not understand the connection of the 5tli nerve with the pneu- 
mogastric. 

A. The pneumogastric supplying the stomach is affected directly from 
an exciting cause, the impulse passes along the pneumogastric going directly 
to the medulla, which is the center for all of these nerves which arise from the 
floor of the fourth ventrical, and then directly out over the 5th cranial nerve. 
It has been proved that an impulse can be sent from a nerve, through a center. 
and out over another nerve. 

Q. In referrmg to the back Vv'ork we have gone over, I do not quite un- 
derstand why a click in the neck in the cervical region should be more serious 
than in the rest of the spine. 

A. Well, I so stated simply because it has been my experience that I 
could find these noises all along the spine when they mean nothing at all, the 
subject being perfectly healthy. While in the cervical reii'ion it seemed to me 
that there was alwaj^s some slight break or contraction between the parts, like- 
ly enough to be serious. It showed that the blood supply had been cut off, 
thus diminishing the supply of lubricating material in the synovial membrane 
I said that it was in general more serious, because my experience in practice 
seemed to bear out that point. 



37 

Q. In the case of a lateral displacement of the atlas, would you exaggerate 
the condition also? 

A. Yes, sir, as far as possible, but to set an atlas is quite a technical 
matter. I will take that in detail later. 

Q. Suppose there was a spinal curvature would you set it in the same 
way you would a single vertebra? 

A. In that case you would use the same general method, but you would 
begin at one definite point and try to set it, and then work upon the next ver- 
tebra, and so on. 



LECTURE YIII. 



At the last lecture I commenced to consider the osteopathic theory of work 
upon nerve centers. That is what I have called the subject in general, al- 
though it includes not only nerve centers, but nerve distribution and blood 
supply ; how the osteopath works by external manipulation upon the surface of 
the body, gaining results internally. I first defined the terms stimulation and 
inhibition, and showed that while they are used in several senses, the osteo- 
path uses them in the usual sense. Our conclusion was that the osteopath was 
justly entitled to the use of these terms, stimulate and inhibit nerve action, and 
that he works in the same manner as the physiologist when he is experimenting 
upon these nerves. That since the physiologist, gaining results which were 
similar to normal, reasons that he has therefore affected the nerves in a man- 
ner similar to normal, the osteopath should be allowed to say that, since he has 
gained results similar to normal, he has also affected the nerves in a normal 
manner. As to the term "desensitize", I was not fully informed. I have 
since found that there is no such word, it is not in the Century Dictionary, and 
I think I had better dispense with the use of it. However, we do the thing, 
whether we have the word the same or not. That is, taking away the sensi- 
tiveness from a nerve, or the excitability, or its excited condition, is really an 
inhioition of nerve force. Or it may amount to this, that we affect the con- 
ductivity of the nerve, and that is what I meant by the use of the word desens- 
itise. Since it was simply the improper use of the word, and not any confus- 
ion of points, I do not think we have to yield any point to the authorities 
there. We then are privileged to say that by external manipulation we have 
really stimulated or inhibited a nerve. If we have worked upon nerves and 
upon nerve centers in that way, we have produced certain results. The point 
that the physiologist works externally only sometimes, while we work outside 
altogether, does not make anj^ difference with argument, from the fact that we 
have as broad a range of results to show for our work as he has by both ex- 
ternal work and work upon the exposed nerve. I think that my position taken 
at that time was sound. 



38 

1. Theory of Osteopathic Work upon Centers. (Coutinued.) — 
Our operators agree that we secure direct results upon nerves by mechanical 
work, and while they do not all fully a^ree in all they say, I gather from the 
communications they have handed me that they all take that view of the matter. 
For instance, Dr. McConnell says; "We affect internal nerve action by man- 
ipulation on the external parts of the body, by a general mechanical stimula- 
tion given to the nervous syste.r.-" He says further, that we stimulate or in- 
hibit sometimes but that he believes there is a general misuse of these terms, 
and that the results which may be expressed in these terms, are not often the 
result of some direct inhibiting or some direct stimulating work that we put 
upon an affected point. But we will bring that point up when I come to take 
up the further definition of these terms according to the osteopathic point of 
view. Dr. Harry Still says, ''Vfe inhibit by pressure or by holding, thus cut 
off nerve action , and break the force between the termination of the nerve." 
Dr. Harry also says that work outside upon the body, that is mechanical man- 
ipulation, produces a direct effect upon the nerves through pressure, thus af- 
fecting sympathetic life through its connection with the spinal nerves or their 
centers. He instanced ihe pneumogastric. Mrs. Still's reply shows that her 
idea is that we either directly or reflexly affect nerves or centers by external 
manipulation. Dr. C. M. T. Hulett well illustrates the theory of our work as 
follows : "Pressure upon a nerve fibre will cause a break in the continuity of 
the semi-fluid axis cylinder ; and if abnormality exists, then the ever present 
tendency toward the normal will tend to restore normal conditions." I under- 
stand him to say that we may obtain that result by pressure upon a nerve, by 
external manipulation, which is the method we employ. Dr. Hildreth and Dr. 
Charles Still both have something to say about this. I could not get their 
communications to-day, but will bring them later. Thus, as you see, there is 
considerable unanimity upon this point. I have not quoted all these parties 
have to say, but I shall quote from them to explain further points when we 
come to them. 

Remember, that this is not the only effect that we get upon nerve centers 
or nerve life, this mere stimulation or inhibition, as we may be privileged to 
call it, but that we do it and get important results. I leave this subject to 
consider a different point — there are other means at the osteopath's command, 
by which he may affect blood and nerve force. These means are important, 
but they are not what we stjde as the most important means at our command. 
They are, however, important as being external, non-medicinal methods of 
reaching deep blood and nerve force. They are not distinctively Osteopathic : 
they are simply adjuncts to our work. One of these is the external application 
of heat or cold. I shall take up later, possibly, the subject of Hydrotherapeut- 
ics and kindred subjects. Green in his Pathology says, "It seems that vascu- 
lar dilatation of deep organs may be produced reflexly by the application of 



39 

stujjes to the skin." They are valuable, then, as adjuncts which the osteopath 
may call to his aid if necessary. I may instance here that in case of inflamma- 
tion following s©me injury, you may find the parts so swollen as to make it im- 
possible for you to determine whether or not parts are broken, or what the 
condition really is. You will frequently find that m such cases you must first 
reduce the swelling before you can apply your osteopathic work. Not to say 
that we do not do it osteopathically, for I believe that we do. In the case of a 
swollen ankle we may by manipulation of the venous flow, loosening the struc- 
tures about the femoral vein, aid in taking down the swelling, but you will 
find that if such cases be of any great extent, you must bring in the application 
of heat or cold. 

You will have to use fomentations and the application of dry heat very of- 
ten, and it is always advisable to have a good supply of liot water near you in 
case you have a patient where it is likely to be necessary. For instance, if 
you are treating a patient for some disorder, and he is continually troubled 
with cold feet while lying m bed, you must use the application of heat, the 
idea being to get the patient as comfortable as possible, and to get a good dis- 
tribution of blood throughout the system ; also to prevent collateral hyperemia 
on account of having too little blood in one part. I think this is a good thera- 
peutic hint for the osteopath. You must pay attention to these details, or some 
such little thmg may hinder to a considerable extent, the results you are try- 
ing to attain. The idea is to equalize the flow of blood throughout the body. 
The apphcation of cold is frequently useful, though we do not use it very 
often. I spoke of fomentations, that is a term applied to a hot, moist applica- 
tion. You will frequently find it useful to w^ing out a cloth in hot water, as 
hot as can be borne, and apply it to parts, repeating the operation frequently. 
That is a fomentation, while dry heat is applied by means of a hot water bag, 
or some such thing. Please bear in mind that these things are good in our 
practice. You may also get a vaso motor effect by apphcation of cold. Speak- 
ing of renal constriction, Howell's Text Book says: ''The same effect (renal 
constriction) is easily produced by stimulating the skin, for example, by ap- 
plication of cold." Remember, please that we as osteopaths do not depend upon 
the use of these agents, but I call your attention to them as valuable, non- 
medicinal adjuncts to our practice, and also as supporting, by quotations from 
standard text books, the contention of the osteopath, that without medication 
the blood and nerve forces of life may be regulated to produce health. This is, 
too, valuable in our arguments with medical men. It all tends against the use 
of medication. I believe that the osteopathic position may be still further 
strengthened by considering the effects produced, on the one hand by the use 
of chemicals, drugs, or electric currents, and on the other hand by the osteo- 
path in his use of mechanical agents. In the first place, drugs and chemicals 
introduced into the svstem alter normal chemical conditions in which the nerve 



40 

must be in order that its normal irritability may be preserved. In Howell's 
Text Book it is stated that the introduction of digitalis, ether, alcohol, water, 
etc., chans^es the condition of the irritability of the nerves. "From all these 
results it becomes evident that the normal irritability of nerves and muscles re- 
quire that a certain chemical constitution be maintained, and that even a slight 
variation from this suffices to alter, and if continued, to destroy the irritability. 
Now, it is the physician, and not the osteopath, who introduces these abnormal 
chemical conditions, thus destroying the normal irritability. I ^rant the force 
of the physicians' argument when he says that he supplies these drugs for the 
purpose of supplying to the body some elements which are lacking, but I doubt 
whether that is the general method of medication. Where digitahs is given to 
retard the action of the heart it paralyzes the nerves and in that case certainly 
it was not given to supply the lack of some such constitubnt in the system. 
On the other hand, the osteopath does not introduce any of these foreign sub- 
stances. He stimulates nature, and nature supplies from the food these vari- 
ous things which are needed to keep the normal chemical conditions under 
which a nerve or muscle is normally irritated. I further quote from Howell's 
Text Book to show the abnormal effects of electricity. "Undoubtedly, chem- 
ical and physical alterations may occur in nerves as the result of the passage of 
an electric current through them, and it would seem that the loss of conductiv- 
ity which they show when subjected to strong currents is to be accounted for 
by such means." "The conductivity, like the irritability of nerve and muscle 
is greatly influenced by anything which alters chemical constitution of active 
substance." Hence it must be that electricity, chemicals and drugs produce 
abnormal changes in nerve tissues. Therefore, I maintain that the osteopath 
may secure better results from his manipulation than may the physician, for, 
whereas the latter introduces into the system those agents which by their nature 
produce abnormal changes in nerve tissue, the osteopath introduces no foreign 
matter. Moreover, he may, through his manipulation, attain results very simi- 
lar to that produced by normal physical exercise of parts of the body. I might 
explain here the effect upon the nerves of an athlete in stooping and jumping. 
He may, for instance, stoop in such a way as that the thorax is bent upon the 
thighs, the knees touching the shoulders, and the sciatic nerve is stretched, just 
as we stretch it in sciatica. There are normal exercises, the results of which, 
if we can judge at all, are exactly similar to results we obtain by giving^ a cer- 
tain motion which is in our stock of remedies, we might say. Thus we reason 
concerning various contractions of muscles, motions of the back, bringing 
elastic pressure upon the parts and thus keeping them stimulated up to the 
normal. I think that the similarity is readily seen between normal exercise, on 
the on*^ hand, and the application of osteopathic methods on the other: between 
the application of violent means such as the use of electric currents. cluMuii'als 
and drugs, and the application of normal exercise to the parts by ostoopathii' 



41 

manipulation. In the treatment of disease, normal exercise differs from osteo- 
pathic treatment, in that the osteopath has the patient passive in his hands and 
can work at will. These are not exercises upon his part, and it may be that he 
being ill would not be able to undergo such exercises of his own free will. 

Remember, please, that the points which I have brought out have been ad- 
duced in favor of the argument that we may work externally upon the body, 
and thus stimulate or inhibit nerve force. But we do not consider that the 
most important part of our work. What we consider more important than that 
I shall take up wiien I come to describe what the osteopath means in the second 
sense in which he defines these terms, and this is but one part of the argument. 
I shall at the next lecture attempt to carry this line of thought a little further 
by quoting from authorities in support of the view that we may stimulate or in- 
hibit nerve force by external work. 

II. How TO Treat the Spine, — (Continued.) — I showed you at the last 
lecture how to treat a spine where a vertebra was displaced laterally. To-day I 
want to show you how to proceed when you find the spines separated. If by 
examination we find that there is a separation between the twelfth dorsal and 
first lumbar, how should we go about to rectify the conditions? How should I 
heal the breach? In such a case of course our method of reasoning is that 
there is a lack of tone here ; there is a relaxation of the ligaments ; we would 
rather expect that, though it is not necessarily so. And in that case, we would 
first go about to restore tone to all the parts here before proceeding further. I 
need not go over the same ground of explaining to you that you thus here 
reach the central distribution of the sympathetics all about this part which is 
lacking in tone, but in this case that would be the first step, and you might al- 
most say the only step, althoue^h that is saying a little too much. The proba- 
bihties are we would not be able to put these vertebrea back into place at once, 
you cannot do that often. Simply thoroughly stimulate and loosen up the 
structures, and patiently await results, and you will gradually see those spines 
coming together. So that your best method, finally, is to stimulate, first on one 
side and then on the other, using the motions I have given you, bring about a 
strengthening of those parts. You need not work just between the twelfth 
dorsal and first lumbar, work a little higher and a little lower, and get a good 
effect all about the parts. Probably this motion of getting the elbows between 
the pelvis and shoulder, and spreading while you have the fingers on the op- 
posite side of the spines, and springing up as you spread, will obtain good re- 
sults. 

Q. If the three upper lumbar and two lower dorsal vertebrae are posterior, 
in that case would springing it in that way tend to bring it back to the proper 
position in time? 

A. Yes, in part. I shall take that up when I consider variations from 
normal curves ; that would be a part of the method, however. 



42 

Probably I would have the patient sit up on a stool in case they are separ- 
ated. You can separate them a little more. Going upon the principle of ex- 
aggerating the defect, spread them a little more, thus allowing a stretch and a 
recoil, which naturally follows, and in that way throw new life to the part, and 
then we seek simply to push them together. You can lift up and push down 
and get the parts approximated in that way. 

Q. In the lecture reference is made to paralysis without loss of sensation, 
do we ever have loss of motion without sensation? 

A. Yes, frequently. You will find that in your practice, loss of motion 
without loss of sensation. 

Q. Do we have loss of sensation without loss ot motion! 

A. Yes, sir, you may have either. 

Q. Is epilepsy caused by displacement of the vertebrae? 

A. Very frequently caused by displacement of one of the upper cervical 
vertebrae ; we find it so in our practice. 

Q. You were speaking of stimulating the circulation in the feet by the 
application of dry heat, is there any practical osteopathic treatment for cold 
feet? 

A. Yes, but in case you have a severe case of cold feet it would be very 
difficult to throw enough blood to those feet to warm them in case the patient 
were very sick. You could not adopt measures strong enough on account of 
the general debility of the patient. But I will say this, that condition yields 
gradually, as do a great many other things to treatment, and people I have 
known who had been troubled with cold feet for years would find, after a 
course of treatment of a month or more, that they were no longer troubled in 
that way, that the general circulation was better than it had been for years. 



LECTURE IX. 



At the last lecture I considered further the theory of osteopathic work up- 
on centers, and briefly, to recapitulate, these were the points I took up: First, 
that our operators agreed in the use of these terms, stimulation and inhibition 
in general, although there is some difference in the reservations they make. 
I also quoted from different ones of our operators to show their opinions in 
the matter. I then called your attention to the fact that that was notthe only 
way, nor yet the most important way in which we considered these terms; 
that there are other means by which the Osteopath may command deep nerve 
force and blood flow, by the ap|flication of heat and cold, which, while not 
being distinctly Osteopathic metliotls, are yet at the Osteopath's command, 
and serve to strengthen our argument that these forces of life can be reached 
fro - the external surface by proper methods, without luedicatiou. 1 iiuotml 



43 

from authorities to substantiate these points. In general, the application of 
heat is better than cold. I compared the effects produced upon the nerves 
by chemicals and by electric currents, as producing a certain change in a 
nerve, producing a change in the chemical conditions under which a nerve 
must be normally in order to be normally irritable, and so I reasoned that 
the Osteopath' s practice was the more rational, since he does not introduce 
these foreign things into the system. Further, I called your attention to the 
similarity of the effects of the Osteopathic work upon the body, and the 
effects on the body of normal exercise; the difference being, in part, that your 
patient being sick is not able to undergo these physical exercises, while in 
your hands he is passive, and these effects may be given without the fatigue 
which would accompany his own exertion. To-day I continue the considera 
tion of this subject. 

I. Theory of Osteopathic Work Upon :N'eeve Centers. — (Con- 
tinued. ) — The arguments advanced in the last lecture may be strengthened 
by quotations from standard text books. Having shown that the Osteopath, 
by means peculiar to his system of treatment, accomplishes results through 
stimulation and inhibition of nerve action that are as worthy of being consid- 
ered normal results as those accomplished by physiologists through methods 
employed by them in experimentation; having shown, further, that the Osteo- 
path accomplishes such normal results in every part of the body, there being 
cases upon record to prove that that is the fact, it therefore at once becomes 
apparent that the whole field of nerve-force, controlling directly or indirectly 
every motion or function of life, lies open to the Osteopath; that wherever 
there lies a nerve of the body capable of stimulation or inhibition, it is his to 
command, providing only that such nerve may be reached by Osteopathic 
methods, either directly, as through pressure, or indirectly, as through the 
blood supply. For stimulation is stimulation, and inhibition is inhibition. 
It makes no difference in fact. I will grant that there may be a difference of 
degree of stimulation or of inhibition. However, having shown that the Os- 
teopath stimulates or inhibits just as really as does the physiologist, the ques- 
tion of the degree of stimulation becomes a secondary one, and one relative 
only to the point in view. Eesults obtained in the cure of diseases in every 
part of the body, and of almost every known form of cureable disease, show 
conclusively that the Osteopath has really stimulated or inhibited nerve force 
according to the end which he has in view. In would be no argument to say 
to an operator that he could not stimulate enough to cause a man to jump 
over a table. His fitting reply would be that such was not the end in view, 
that the end in view, perhaps, was the stimulation of a flagging circulation to 
restore it to its normal force and activity, and that he very readily accom- 
plished that result. So degree of stimulation really makes but little differ- 
ence to us, granted that we have gained results. I believe that there is no 



44 

nerve of the body that the Osteopath may not reach by proper manipulation, 
either directly or indirectly, by pressure, by correction of lesion, by removal 
of obstruction, or by control of blood supply. What that fully means we 
shall see as the subject is developed. 

IsTow, for further argument, in view of the above facts, it is interesting to 
note the following quotations from authorities as confirmations of the claims 
of the Osteopath, since the authorities have made use of such means as has 
the Osteopath to produce effects upon nerve action. Speaking of an experi- 
ment upon the ear of a rabbit. Kirk says: ' 'Division of the cervical sym- 
pathetic produces an increased redness of the side of the head, and looking at 
the ear the central artery with its branches is seen to dilate and become 
larger, and many similar branches, not previously visible, come into view. 
The dilation following section can be demonstrated in a very simple way, by 
pressing the nail of one finger upon the nerve where it lies by the side of the 
central artery of the ear." So that you see that the application of the exter- 
nal force, in Kirk's opinion, is equal to section of the nerve. Again, from 
Green's Pathology; speaking of the vaso-tonic action of the sympathetics, the 
author says: ''The reflex process is generally due to stimulation of sensory 
nerves, the dimunition in tonus produced being more or less accurately con- 
fined to the region supplied by the nerve. Friction and slight irritants, in 
the early stages of their action, produce hyperemia in this way." Thus you 
have another illustration of the application of an external mechanical agent, 
that is, friction. No doubt you also thus set up a reflex action. I shall con- 
sider that further when I apply this argument to work on the centers. I 
quote further from Howell's textbook, "A sudden pull, pinch, twitch, or cut 
excites a nerve or muscle. All have experienced the effect of mechanical 
stimulation of a sensory nerve through accidental pressure on the ulnar ner^'e 
where it passes over the elbow, 'the crazy-bone.' " Speaking of their irri- 
bility, the same text book says: "Stretching a nerve acts in a similar way, 
for this is also a form of pressure, as Valentine says, the stretching causes 
the outer sheath to compress the myelin, and this in turn to compress the 
axis cylinder." This is a common mode of our treatment, as we flex the limb 
upon the thorax strongly in order to stretch the sciatic nerve, that being a 
part of the treatment, and there are certain movements we adopt to stretch 
the brachial plexus in nervous affections of the arm. I quote farther from 
the same source: "A reflex fall in blood pressure is also produced by a 
mechanical stimulation of the nerve endings in the muscle." This, tlieu. was 
a mechanical means, and the fact that we can thus work upon nerve endings, 
which of course occur all over the body in the muscles, gives to us a fruitful 
field for the apj)licatiou of ex^"ernal manipulation. A little further, Howell's 
text book says: "Both the sympathetic and vagus nerve fibers have their 
influence over the heart, deceasinl bv cold and increased bv heat." Now. 



45 

having made these quotations, allow me to call your attention again to the 
fact that I have quoted thus fully for the purpose of showing, out of the 
mouths of the authorities, the fact that the blood and nerve supply may be 
regulated by external manipulation, I have quoted them for the sake of the 
argument, not for the purpose of giving license to our practice, because we 
demand license only on the results which we have obtained. Nor by the above 
quotations which I have made do I intend to yield a point and say that the 
Osteopath can obtain only such results upon nerve action as is attained by 
physiologists by external manipulation, because I believe I have shown that 
the conclusion is fair that the Osteopath can, by his method, affect any nerve 
in the body. Hence, I shall deem it competent to give you vaso-motor cen- 
ters, etc., with the understanding that the Osteopath has a right to regard all 
such as legitimate objects of treatment, as his facts to revert to in argument, 
and as his equipment for work in the eradication of disease. As I said, the 
more important part of how the Osteopath stimulates or inhibits is still to 
come, and I shall pursue this subject for a lecture or two further. 

II. How TO Treat a Spine. — (Continued.) — At the last lecture I at- 
tempted to show you how we reason and work in case the spines were separ- 
ated. In to-day's lecture I wish to take up the question of how we would 
work in case the spines were approximated. That is, how would we separate 
those spines! If, in passing your fingers down the spine you come to some 
place where the spines of the vertebrae are too close together, and this is a 
very common lesion, your reasoning in that case would be that there had been 
some injury, at that point, to the spine, perhaps a sudden Jerk or a twist, 
which had resulted in irritation; that too much life, and the form of nerve 
and blood force, had been thrown there, resulting in a thickening of these 
ligaments, thus contracting and binding those parts together. When you 
come to study pathology you will find that any irritation sufficient to set up 
an inflammation is very likely to be followed by the formation of new connec- 
tive tissue or the tickening of the existing tissues. Thus, you will find that, 
reasoning that too much force has been directed to these parts, our work is to 
overcome the results of such misdirection of energy. We set about to do it 
largely by the same manipulation as we would adopt in the case of approxi- 
mating spines, at least in the first stages. We would loosen up all the parts, 
very likely you would find a tension in the ligaments at these points as well 
as in the muscles. The muscles show that they have been tensed by the 
closeness of the vertebrae. Having loosened up all the muscles, we would 
then spring the spines upward, getting this stretching motion that I have be- 
fore described. I would work with sufficient force, according to the size of 
the patient, to stimulate these parts and set up what would seem to be a free 
action as far as possible. You can then operate by flexing the knees up 
against your own body, and get considerable purchase on such a point as 



46 

that, and while it is rather a strained position for the operator, and I cannot 
say that it is always comfortable for the patient, it is a very good way to 
work, because you have your patient in such shape that you will hardly in- 
jure him by lifting him, as I have done, fairly off of the table. By this 
method yon may use considerable force, but of course you must not be rough. 
I spoke to you about a smooth spine, meaning a spinal column which showed 
all along it that tlie spines were approximated and bound down close to- 
gether. Now, you have a variable condition there, it may be so bound to- 
gether that it will be quite rigid, or it may be capable of considerable motion, 
but having this peculiar smooth feeling all the way, so as to lead you to sus- 
pect some trouble. I have had a number of cases of that kfnd, where the 
whole spine was in that condition, or some one particular part of it, and al- 
most invariably there was a history of some strain or jolting or twisting that 
had set up an irritation along the spinal column, and had resulted in a tight- 
ening of the ligaments which has resulted in the approximation of the verte- 
brae. In such a case the manipulation would be largely as I have shown. I 
would simply loosen up first all the muscles along the spiue, remembering to 
work against the grain of the muscle, of course working on both sides. A 
good way to do that by the motion I gave you with the patient on his face; 
you can exert considerable force, and as he is relaxed you can loosen muscles 
very nicely. Having done that I would proceed to spring the spine along its 
various parts. By flexing the knees you can sping the spine in the lumbar 
region, and by using the arm as a lever you can spring the spines in the up- 
per region. Of course it is rather difficult to spring the spines between the 
shoulders; one good way to work there is to get the elbow against you, and 
work along the spine by holding and stretching in that way, your object, of 
course, being to loosen all of these ligaments and to relax whatever is hold- 
ing the spines together. 

As to the misdirection of energy in a part resulting in their being bound 
together, it may of course be entirely possible that at this present time there 
is not a misdirection of energy, but there has been, whether past or present 
it does not make a great deal of difference. The misdirected energy may 
have acted for a time sufficient to thicken and perhaps to contract the liga- 
ments, and then diffused to other parts of the body, so that tliis may be an 
old result without there being at present any misdirected energy or life at the 
point of lesion. 

I would then have the patient on his back and would stretch the lower 
part of his spine by taking one of his limbs and my assistant the other, and 
working both limbs up toward the chest, thus getting a purchase on tlu^ lower 
part of the spine. You are not very lik(My to hurt the patient but you must 
be careful because different people are different in that respect, and you may 
do considerable hurtine;, if not actual damage, in that Mav. Aoain. if \ ou 



n 



47 



have such a case you want to bring traction on the spine as much as possible; 
and it is a very good way also to take hold of the patient by the occipital 
X)rotuberance and the inferior maxillary so as to exert traction enough there 
to pull the patient along the table. You are not likely to hurt the patient 
with that degree of force, unless it be a delicate lady. Eemember that you 
have already sprung the spine by working all along on each side. One pre- 
caution you must observe when you have the neck extended in this way, re- 
member that the neck is less supported than the other parts of the spine, and 
if you should twist at that time you might cause a dislocation, the articular 
processes might slip out of place, so it is advisable not to attempt to twist 
when you have it extended. If you wish to twist the neck, do it when the 
spine is not under traction. In order to be thorough the treatment must be 
applied to the whole length of the spine, and when you had the patient upon 
his face you would have loosened up the muscles along the lower regions of 
the spine, the sacrum and coccyx. You may get considerable force by put- 
ting the knee against the sacro-iliac articulation and springing the pelvis. 
You must relax aU the ligaments, you should loosen up all about it as well as 
further above. Eemember that your work has been simply to loosen up parts 
which through misdirected life have been drawn together. Of course, when 
you have such a condition you may have almost any result, that is, results 
affecting the body through the nerves in almost any way. As a general rule 
I think you will find that the results may not be marked, but may be general, 
and you may have a case of general malnutrition, or neurasthenia, or some- 
thing of that kind. I would then set the patient on a stool and use the mo- 
tion I showed you at the last lecture, then you can get hold along the spine, 
generally it is better to work from the bottom up, though it does not make 
much difference; I just hold in there, bend back a little and bring straight 
traction as I ascend the column. That is a very good way. You may pro- 
duce the same result and I think get a little better stretching motion by taking 
a turn as you work, you would be more likely then to stretch all the liga- 
ments about the vertebrae. 

In case you have a spine misplaced anteriorly, you will have something 
which is rather difficult to deal with. In such a case you must depend largely 
upon the effects of the general strengthening which you give to the parts to 
work the spine out into its normal position, as you must in other cases 
also. But when you have the spine anterior it is very difficult to get hold of 
the vertebra or to influence it. However, Mrs. Dr. Patterson makes a point 
of getting hold of the spine as much as possible and working at it. In case 
of dislocations of cervical vertebrae it is a good point to examine internally, 
and when the dislocation is considerable you may find a protrusion into the 
pharynx. In such a case you would use not only the method I told you of, 
trying to reach the spine, but would thoroughly maniiDulate every point about 



48 

it, and would spring it each way. You might also sit the patient down and 
go through the lifting motion. There is one other method that I think would 
be helpful, that is, your spine being anterior, and going upon the principle 
that we sometimes adopt, of exaggerating the defect, you could bend the pa- 
tient backward, and by placing the knee in the back and raising the arms 
above the head (you must be careful with this motion) that would exaggerate 
the defect, it would loosen the ligaments along the anterior part of the spine 
which are already stretched, and which you wish to stretch a little more in 
order to get the effect of the recoil, and then by relaxing and allowing the pa- 
tient to drop forward again we get the recoil. Then there is another point 
which I think will be helpful to you, it is practically the same as I showed 
you, as you work along the spine, the idea is that you get the bodies of the 
vertebrae to move one upon the other. Mr. BoUes first spoke of this to me. 
You get the same result as when you move your body by working your feet 
along the floor. I think you may very readily get such a result by working 
the bodies of the vertebfe on against the other. 

In case there is a spine posteriorly, what would you do"? I take up these 
points in detail as I went over them in examination of the spine, although 
the method of treatment is largely the same. If the spine is posterior you 
would bend your patient in this way, simply to exaggerate the defect and 
then you could turn him to either side and get the effect of the recoil by push- 
ing him backward. Of course in such case you must be careful not to use 
too much force and not to strain the parts beyond what they would normally 
stand. 

In examination of the spine I spoke to you concerning the ligamentum 
nuchae and tbe importance it sometimes bears in our treatment of the spine, 
mentioning the fact that I have often found cases of headache which would 
yield to treatment only when the ligamentum nuchae was relaxed. By care- 
fully examinino^ along the furrow just below the occipital protruberauce you 
may find that the ligament is tense, you may find that it presents a firm re- 
sistance to the hand ; the patient can also feel it by stretching the head for- 
ward ; he will feel that the ligament is tense. . Naturally, in projecting the 
head forward, one should not feel a sense as of a check rein there, but in case 
of cold I have frequently found it distinctly upon myself, have felt a sense of 
tightness along that region of the neck, and by examination with the hand there 
I came to the conclusion that there was no other reason for the trouble than 
that the ligament was tense, and I think that that was really the fact. The 
way to stretch that ligament is very simple. I usually just fiex the head di- 
rectly upon the thorax, admonishing the patient to lie with his weight down, 
just to let his weight fall against my hands, and I raise up in that wny witli 
sufficient force to raise the shoulders off the table. That would be a gooti 
movement to adopt in stretching of the spine when the whole spine was smooth 



49 

or tense. That, together with flexing of the two knees against the shoulders 
would make a very good extension movement. In such a case of tightening of 
the spine it is a good idea to advise your patient to hang himself, not literally, 
but to catch hold of his closet shelf or the top of the door jam and bring the 
weight of his body upon his arm muscles. That would tend to relax the spine, 
and it is a very good way to relax the lumbar portion of the spine, as it is not 
so much supported by attachment to the shoulders as the upper parts of the 
back, from the twelfth dorsal up. I have often heard Dr. Harry Still advise 
some such stretching motion. 

Q. When you have relaxed the structures along a smooth spine, would 
you give the stretching treatment at the same treatment? 

A. Yes, sir. 

Q In the case of a vertebra being anterior, placing the knee on the 
spine, would you put it above or below the vertebra that was anterior? 

A. Well generally just about that point. You of course regulate 3^ our 
force, and I do not think you are in any danger of pushing it further forward, 
but the general idea there is not to bring pressure upon that point, so much as 
to give a fulcrum against which to work, and letting the general tendency of 
the forward motion of the spine do the work. 

Q. Would stretching the ligamentum nuchae have a tendency to get pos- 
terior curvature out between the shoulders? 

A. Partly so, though we do not usually pursue that method for that par- 
ticular thing. It would help. 

Q. In stretching the ligamentum nuchae forward, is there any danger of 
acting upon the nerves that go to the stomach? 

A. I have never found any trouble in that way ; I hardly think there would 
be, unless in case of defect, as you thus stretch the whole spine, you might 
get an effect upon the splachnics. 

Q. In case of anterior displacement of the 4th cervical, would the stretch- 
ing of the ligamentum nuchae have a tendency to draw it out? 

A. It would not have much of a tendency to do that, it is true there are 
slips that run down to those vertebrae, but you would hardly get enough ten- 
sion by those slips to bring tension upon the vertebrae. 

Q. In separation of the spines there is a weakness of the ligaments and 
in approximation there is tenseness, and our treatment seems to be very much 
alike, how do we know that the same treatment will cause an opposite effect! 

A. That is good question. Of course there is a certain lesion, in one 
case there is an approximation, m the other a separation j there would be no 
trouble in diagnosis. You must not misunderstand the use of the terms, too 
much or too little life directed to a point. That is true, but there may be ex- 
ceptions, in case of a sudden wrench or jerking of the vertebrae apart, which 
frequently happens, there would not necessarily be a relaxation of the liga- 



50 

ments ; but that is a general method of reasoning, I have mentioned it for the 
sake of its importance. But as to your question how we could get the differ- 
ent effect by practically the same treatment, it simply amounts to this: that in 
each case you are trying to stimulate parts ; in one case where there is a tight- 
ening of the ligaments you use a stretching motion to draw them apart ; in the 
next case where they are separated, granting there is too little life there, you 
wish to stimulate them by stretching them, and getting the benefit of the recoil 
and throwing more life to the part. 



LECTURE X, 



At the last lecture I brought out the point that from the preceding argu- 
ments it became apparent that the whole field of nerve force was open to the 
Osteopath, and that the probability was that there was no nerve in the body 
which he could not manipulate either directly or indirectly, thus opening up 
to him the whole field of nerve life. That the question of degree of stimula- 
tion was not an important one, since the Osteopath manifestly could stimulate 
or inhibit, that is, could affect the nerve in sueh a way as to gain the desired 
end. I then quoted from certain texts, one from Kirk concerning an experi- 
ment upon a rabbit's ear, section of the nerve followed by vaso-dilatation of 
the ear, he showing that the same thing could be done by pressure of the 
thumb nail upon the nerve. Also a quotation from Green concerning the re- 
flex process being generally due to stimulation, which might be applied me- 
chanically. The general idea of those quotations being to show that we could 
from the books get authority for what we have been arguing. That that did 
not limit us, since we have shown that we can gain results in every part of 
the body; hence, we are not limited to the same kind of experiments as the 
physiologist when he gains results by external experimentation, but since we 
can reach the whole body, we are privileged to say that we can stimulate the 
nerves in any part of the body. To-day we continue the same subject. 

I. Theory OF Osteopathic Work Upon Centees. (Continued.) — 
The subject grows under my pen, and I do not know but what there will be 
several more lectures before we shall have concluded the subject. I have 
been calling your attention to the fact that the view I gave you of mere stim- 
ulation or inhibition, direct or indirect, was not the important thing that the 
Osteopath considers when working upon nerve centers. I liave rest.\j'vod 
that until now, calling it the second view taken by the Osteopath in regard 
to stimulation or inhibition of nerve action. This is that by the renunal of 
lesion, that is, some obstruction which has been preventing the direct flow of 
blood or nerve force, the tendency toward the normal is left free to act. And 
that is the kernel of oui- work, I believe. Xot that we do not do the otiier 



51 

things, but I wish to lay stress upon the fact yoo must look for lesions, and 
having found the lesion and having removed it, you do not have to stop to con- 
sider whether it is stimulation or inhibition that you must produce. After you 
have the lesion removed you ha^e the ever present tendenc}^ toward the normal 
to regulate the activity, and leave Nature to do the work. In case the lesion 
or obstruction had been such as to inhibit nerve action or lessen the conduc- 
tivity of the nerves, and thus prevent the proper conduction of nerve impulses, 
and you removed that lesion, the result would practically be stimulation. For 
instance, yoa might have had the tightening of the spine along the region of 
the upper splachnics resulting in an imgingement upon the branches connecting 
with the sympathetics in that region, thus interfering with the nerve force to 
the solar plexus and to the stomach. The result might be a case of dyspepsia. 
There you have an inhibition of nerve force 5 you have not enough life to digest 
the food put into the stomach. When you have removed that obstruction, 
what have you done? You have taken away that obstruction, you have left 
Nature free to act, and she will go about stimulating and renewing: the nerve 
force at that point. What you did was to correct the lesion, you did not 
stimulate nor inhibit, you did not care about that particular point in your 
treatment. On the other hand, if the lesion has been just sufficient to bring 
irritation upon the nerve and to keep it stimulated to an abnormal degree of 
activity, that is what you would call abnormal stimulation of the nerve, then 
by removal of the lesion, you would obtain the result of inhibition. That is, 
you would remove the irritation, leaving free the tendency toward the normal 
to act, and the result of Nature's work would be a quieting of the nerve, and 
thus a cure. You have simply corrected the lesion. A very familiar example 
of such a condition is in female troubles ; you may have an uterine tumor af- 
fecting the hypogastric plexus, disturbing the kidneys. If that tumor is taken 
down or removed the result would be stimulation, but you have simply corrected 
the lesion. That is the most important thing that the operator does ; he re- 
moves lesions in the great majority of cases. The lesion may be lack of nutri- 
tion, that is, of blood-supply to the nerve ; it may be a displacement of some 
important part, bringing direct pressure upon the nerve. No matter what the 
lesion may be, the Osteopath's knowledge of anatomy, and his trained sense of 
touch enable him to discover abnormalities in anatomy and gives him his pe- 
culiar adaptibility for the treatment of disease. I do not know that it is be- 
cause we are any wiser than physicians, because I do not think we are, but it is 
because our svstem differs from others radically; we look at disease from an 
entirely different standpoint. I hope later to take up that subject, the di lifer- 
ent systems and schools of medicine and their modus operandi. The result of 
our method is that we make a correct diagnosis of the case. You remember 
that Dr. Hildreth put especial emphasis upon that; stating that the strong 
point ot Osteopathy is that we make a correct diagnosis ; that we diagnose 



52 

from a physical standpoint. In the ^reat majority of cases the Osteopath 
diagnoses and removes some displacement, hence the importance of looking for 
the lesion in every case. To illustrate the difference between the position taken 
by our medical friends and our position : When I was visiting at home about 
a year ago, a young man called on me to be examined. It was the same old 
story of a dislocated hip, the leg being shorter than it ought to be by about 
an inch, and there being n tumor upon the side of the sacrum, made of course 
by the protrusion of the head of the femur. Now, he told me how the acci- 
dent had happened, he had had quite a severe fall from a wagon. He told how 
the doctor had examined him, simply by setting him on the other side 
of the room and questioning him. That illustrates the difference in 
our methods. You will find that in your practice, there will not be a month 
pass but that you will find some similar case where the doctor has simply sat 
across the room and questioned the patient and has not made a thorough physi- 
cal diagnosis. So if you will take the trouble and will thoroughly acquaint 
yourself with texts on physical diagnosis, I think you will be amply repaid. 

By quoting from the operators m the building I wish to show that they be- 
lieve that we reach centers and affect nerve force directly by the removal of 
lesions. I quote first from Dr. Hildreth : ^^In the first place, where a lesion 
may exist, by manipulation or rather by Osteopathic treatment you reduce the 
lesion, you re-establish a natural circulation, and m so doing you carry away 
any obstruction which may exist. You thus remove the obstruction to nerve 
centers. If there be a contracted condition of muscles, it affects these centers : 
the dislocation of a vertebra, or recent injury of tissues sometimes without dis- 
locations, all these conditions may produce disease of the different nerve cen- 
ters of the spine, and the effect of Osteopathic treatment in all these conditions 
is to help to re-establish a natural nerve current, thereby restoring a normal 
condition of circulation, thus relieving all tensions on nerve centers. With 
this done gradually health cannot help but follow, for a healthy condition is a 
natural condition." Thus you see that Dr. Hildreth's idea is that the Osteo- 
path adjusts abnormalities existing in the anatomy and simply leaves Nature 
free to restore a condition of health. I wish to add this in addition to what 
Dr. Hildreth has said: In some few cases you will find that all that is necessa- 
ry to do is to stimulate the blood supply. The blood supply acting through a 
longer or shorter time removes the lesion. What you have done in that case 
was not to remove the lesion, but you have stimulated the blood supply, which 
you have done through direct manipulation of the nerves controlling circula- 
tion. In that case the matter is reversed, the cart before the horse. You 
have to do this in the case of rheumatism, wiiere there are deposits in articula- 
tions. That of course is not a primary lesion, but it is a lesion. You must 
stimulate the blood floAV so that it will absorb those deposits. We somotinuv 
absorb small abscesses, or thickening parts in that way. Y^ou first remove the 



53 

primary lesion, aod then the secondary result has been to remove the other le- 
sion. Of course we cannot always brin^ things down to fit theories. I quote 
further from Dr. McConnell : -'Our Osteopathic work is largely performed m 
correcting lesions involving nerves or nerve centers, also in correction of le- 
sions of the arterial, venous, lymphatic, and other fluids that bear a relation to 
such centers. In some few cases we simply correct lesions of nerves passing 
from or to the brain, or the cord, or sympathetic chain, from or to the organ 
affected." Thus you see that Dr. McConnell's idea is that we work upon 
nerve centers, but that we do it by affecting either the fluids of life or the 
nerve forces of life. His idea being, of course, that we remove lesions, as his 
words imply. He also says that we sometimes work to restore organic activit}' 
or health by removing a lesion through a nerve, that is, independent from its 
center. That is, you may have a pressure upon a neave, and removal of that 
lesion may not affect the center. From Dr. Turner Hulett I quote as follows : 
"Pressure upon a nerve fiber would cause a break in the continuity of the semi- 
fluid axis cylinder and the damming back of its current upon its center of sup- 
ply. If any abnormality exists, then the ever present tendency toward the 
normal will tend to restore normal conditions. If the previous condition was 
abnormal stimulation, then inhibition or desensitization was accomplished ; if it 
was sub-normal, then stimulation was accomplished." This expresses very 
nicely what I have tried to show you, that whether you stimulate or inhibit de- 
pends upon the nature of the lesion that you remove. I might quote further 
from other operators, but lack of space forbids. I hope this subject is not 
growing threadbare. We hear a great df al about removal of lesions and stim- 
ulations, etc., and perhaps you get a little tired of it, but I think it important 
to get these things correlated in some definite system of argument, so that we 
may have together the points relative to Osteopathy. 

We have thus answered two of three questions propounded. First, what 
does the Osteopath mean when he says he "stimulates or inhibits ;" Second, 
how does he affect internal life by manipulation upon the outside of the body ; 
and we have partly answered the third ; How does he affect centers. I have 
taken this up in detail because these questions are some of the most bother- 
some to the young Osteopath, and to the older ones as well, sometimes, and if 
you are prepared with arguments, you may retain many a patient by explain- 
ing these things to him in a logical way. 

Now, as to how we wojk upon centers, I wish to carry the argument a lit- 
tle further. From what I have quoted from Doctors Hildreth, Hulett and Mc- 
Connell you see that they believe that we work upon centers first, by the re- 
moval of lesions or obstructions, and second, by direct stimulation, and I think 
there is no doubt but that we do affect centers. What I have quoted from 
them was given to me in reply to the question, "How do you affect centers in 
the spine?" I wish to call your attention to the fact that the conclusion is in- 



54 

evitable from what lias been said that we must reach nerve centers, not simply 
nerves alone. Certain facts which we show bear out this conclusion. Speak- 
ing of the sympathy between the area that is supplied by the 5th nerve and the 
area which is supplied by the vagus nerve, Dr. Jacobson, Dr. Hilton's editor, 
says : ''This sympathy is an example of a reflected sensation in which the con- 
nection between the nerves concerned takes place in the nervous center." 
Thus yon have your effect running up one nerve through a brain center and 
down another nerve. Now, if you have a lesion affecting the periphery of one 
of these nerves and you remove that lesion, you have naturally affected the 
center in the brain, there is no doubt whatever of that. He gives a case of ob- 
stinate vomiting in a child, which was cured by simply removing from each ear 
of the child a bean which had been introduced in play. There was a stimula- 
lation of the 5th nerve, the impulse must have gone through the floor of the 
4th ventricle out over the vagus to the stomach. Of course there is a connec- 
tion of the 5th nerve and vagus by means of the sympathetic, but it is indirect, 
and it is prol^able that the nerve center -was the connectine* link, as Dr. Jacob- 
son says. Again, we must reach nerve centers, because by the very definition 
of reflex action, which we know is an action caused by an impulse sent back 
along a nerve to a center and then out. Prom its very definition, if we cause 
reflex action by manipulation, the inference is inevitable that we affect centers. 
That we may do this is shown in performing the experiment for tendon reflex. 
This is very easily done by crossing the leg at about right angles and then get- 
ting the reflex by tapping the tendon. That is a reflex action. You have sent 
the impulse from the nerve endings in the muscle back to the center in the 
cord which governs the nerve supply of the muscles of the limb, the gluteal 
muscles have contracted and thrown the limb out. So you have affected the 
center. Again, ever}^ time we set up a vaso motor action we have probably 
acted upon a center. Howell's Text Book snys that vaso-motor nerves can be 
excited reflexly by afferent impulses conveyed either from the blood vessels 
themselves, or from end organs of sensory nerves in general. Of course the 
thing is proven the moment you show that vaso-motor actions are reflex actions 
I have instanced here the bleeding of the nose, epistaxis, stopped by irritating 
the superior cervical ganglion of the sympathetic ; simple stimulation of the 
neck at that point has stopped bleeding of the nose. The conclusion is that 
you have acted through a nerve center. 

I have shown first, that we affect a nerve and its area of distribution direct- 
ly, instancing the result of pressure of the ulnar nerve where it crosses the 
"crazy bone" so-called, thus you have numbness in the hand: you have affect- 
ed that nerve in its area of distribution directly, not through a center. Seconil. 
we affect a center by removal of a lesion, the beans in the ear being the exam- 
ple cited. And third, we affect a center without removal of lesion, but b\ the 
effeect upon the nerve, as in the car of the rabbit, there was no lesion reinovod 



00 



when we press on the nerve, we acted on the nerve back through the center 
and got our effect. Those are at least the three different ways in which we 
may affect nerve action. 

II. How to Treat a Spine. (Continued.) I have examined this gentle 
man and find the curves of his spine are not normal. What I wish to do is to 
work inward this curve in the lumbar region, and wish to make more pro- 
nounced this curve in the upper dorsal region, because it is flattened, while 
the other is drawn out a little posteriorly, thus you have a somewhat staigtit 
spine. At the risk of being tiresome I bring these points up in detail as I took 
them up in examination of the spine. I think you know what to do here as 
well as I ; I have shown you how to approximate or spread vertebrae, and you 
would treat by a combination of the methods I have shown you ; the relaxation 
treatment with the patient on his face, or springing of the spine all along, the 
relaxation of the ligaments and muscles, and thus of the blood and nerve force 
to those parts. By a combination of those treatments you would tend to 
strengthen the normal curves. You would thus remove the lesion, which 
would be the tightening or tension that had thrown them out of their normal 
curves, and would leave nature free to act. You cannot quickly replace those 
vertebrae in their normal curves ; you must strehgthen gradually and build up 
the spine in order that it may take its normal position. This tendency toward 
the normal is of great use to the Osteopath. 

You may find the coccyx in almost any position, either anterior or to one 
side. What you must do is to give a local treatment. The method of digital 
treatment is to first place the finger along the natural curve of the coccyx, and 
by working from side to side free up all the ligaments and tissues thereabout. 
In this way you loosen everything over the foramina where the nerves emerge, 
or any binding down which may have occurred over the nerves directly. You 
have inserted the finger and have turned it so that you have simply worked 
every side ; you must thoroughly relax before attempting to reset. This must 
be done not only internally, but you must thoroughly relax all the muscles ex- 
ternally. It will take some time, but you can at each time you treat the pa- 
tient bend the coccyx toward its proper position. Of course there are lesions 
of the coccyx which may be set immediately. In general, it is recent disloca- 
tions that yield thus^ quickly to treatment. When it is chronic, as it usually 
is, the man usually did it when he was a boy riding horse back or some such 
way, you will have to go slowlj^ Suppose the coccyx were tending to be 
slightly curled up. as is frequently the case, you must simply spring it back> 
wards each time. You must go according to the conditions, and must con- 
stantly spring the spine toward its proper position. I think I explained the 
troubles which may follow this displacement, and I do not need to take them 
up now. 

The sacrum may be anterior or posterior. I shall take that up more in de- 



56 

tail when we come to the consideration of the pelvis itself. But, supposing it 
were posterior, we would at first, of course, loosen up all the tissues, muscles, 
and ligaments, and then adopt the method that I showed the other day — get 
your knee against the bulging portion and spring it inward, a direct apphcation 
of the treatment to the displaced part. It is a good deal like putting a coccyx 
back into place ; by training it in the way it should go. Now, you may also 
get the same motion that I showed you and spring the sacro-iliac articulation in 
this way. Then have the patient lie on his back and you can get a very good 
motion for the sacrum in this way : Your hand is placed m this position ; the 
knuckles forming one fulcrum and the tips of the fingers the other ; there are 
two fixed points, you have the ends of the fingers placed against the sacro-iliac 
articulation, and your knuckles against the table. You thus have two fixed 
points, and you can in this way relax, by an upward, downward and outward 
motion ot the limb, all of the muscles and ligaments. The weight of the pelvis 
is upon those two fixed points, it gives a considerable spring there, and is a 
very good motion. In case the sacrum is anterior, of course it is very hard to 
apyly any direct treatment to it, but use the motion I have just shown you ; 
stimulate and relax every part, and depend upon the tendency toward the nor- 
mal. You might, by getting pressure upon the side of the pelvis, spring 
down, but I doubt if you could do much in that way. Your tendency, how- 
ever, would be to approximate the innominates and to cause it to bulge out. 



LECTURE XI. 



At the last lecture I continued the consideration of the theory of Osteo- 
pathic work on centers, calling to your attention the second view taken by the 
operators as to how we stimulate or inhibit nerve action, the idea being that as 
a rule we remove some lesion, and that that is our strong point in diagnosis — 
to find some lesion which we may reduce to the normal, and thus, if the tenden- 
cy before was toward stimulation, you have removed the lesion and allowed 
nature to tend toward inhibition, and vice versa. Thus you do not have to 
split hairs over the question as to whether you employ a certain motion to 
stimulate and a certain other motion to inhibit. That is, as far as lesion goes ; 
you have removed the lesion. I quoted from different ones of the operators to 
show that that was the view generally held. I also called your attention, in 
line with what Dr. Hildreth said, to the fact that sometimes you stimulate 
blood-supply to remove the lesion, which although secondary is still a lesion : 
as for instance we stimulate the blood and nerve force to remove deposits in 
rheumatism, and to cause absorption of abscesses, and things of that kind. 
Thus I had answered two questions propounded and partly the third, as to the 
effect we have upon nerve centers. Then I went further into the question of 



how we might affect centers, briD^ing to your attention the fact that the quo- 
tations I made from the operators were given in response to that question, and 
one way was by the removal of lesions, another way was that in any manipula- 
tion of the nerve we must very likely affect centers, as for instance, in getting 
a reflex effect, because from the definition of reflex action we must have affected 
the center, and we often produce reflex action by work upon a nerve, not a cen- 
ter. I instanced a case of obstinate vomiting produced by the irritation of 
beans in the ears. The fact that you have removed the bean shows that you 
reached the center ; that you worked through a brain center ; up one nerve and 
down another nerve to the periphery, to the organ supplied by the nerve. 
And the fact also that we can produce vaso-motor action shows that we have 
affected centers, since vaso-motor actions are essentially reflex. Thus I showed 
that we may affect a nerve by three ways : 1st, we may directly affect it and 
its area of distribution by direct work ; 2nd, we may affect the center by re- 
moval of lesion, as when we produce a reflex action. To-day I continue the 
same subject. 

I. Theory OF Osteopathic Work UPON Nerve Centers. (Continued.) 
In the December issue of the Journal of Osteopathy, a theory was given in an 
article by Dr. Lawrence M. Hart, one of our recent graduates, which I think 
was worthy of notice. It was well received at the time, I believe, and I have 
thought that it contained points which would be worthy of our consideration 
this afernoon. His idea is that we always remove lesions. His theory, in 
brief, is this : that contractures of muscles occur along the spine, these con- 
tractures along the spine, he says, act in a way to mechanically shut off the 
blood supply in the branches supplying the spinal muscles themselves, collat- 
erally producing a hyperemia in the blood vessels running to the cord, ard in 
that way stimulating the nerves, irritating them, and thus leading to inhi- 
bition, the final result always being an inhibition, and the lesion always being 
contracture. There are certain points with which I do not agee, I will call 
those up later, but I will go over the reasoning that he has followed, bringing 
out his points. In the first place, he says there are two ways in which a nerve 
may be affected through its blood supply, and I think that is true. In the 
first place, you may have anemia of the nerve, that is, total lack of blood sup- 
ply, thus robbing it of its nutrition and leading finally to a de3:enerated nerve, 
and thus paralysis of the part supphed follows. In the second place, you may 
have hyperemia of the nerve, which he claims leads to an irritation, there be- 
ing too much blood thrown to the part, leading to abnormal activity, this leads 
to too much stimulation, resulting in inhibition. Thus, in one case from 
anemia and defeneration you have paralysis ; in the the other case you have 
practically the same, an inhibition which is Hable to be more temporary, be- 
cause it is produced by an over-supply of blood and not by starvation. Thus 
you see that his argument leads always to the one result of inhibition. He 



58 

calls our attention to the distribution of the blood supply to the spinal cord, 
showing how the branches from the vertebral, intercostal and lumbar and oth- 
er arteries in their respective regions run to supply both the cord and the spinal 
muscles, the same branch supplying both, that is, dividing to supply botti, the 
posterior division running to the spinal muscles, and the other division run- 
ning to the cord and its membranes. Thus he shows the close relation between 
the blood-supply, and states the fact that from the occiput to the coccyx, all of 
the muscles and parts of the cord are thus supplied. Now, his argument here 
is that in contracture of muscles, the lumen of the vessels being thus practical- 
ly closed, the over supply of blood is sent through the branch which supplies 
the membranes of the cord, thus producing a condition of hyperemia about the 
cord. In the first place, this would result in throwing too much blood supply 
to the nerves in question and the nerve centers of the cord, the result would 
be that by over blood supply there would be over stimulation, leading finally 
and naturally to an inhibition of nerve force, and thus you see there would 
always be inhibition. Now, in relieving this condition we of course simply 
take away the lesion, we, by our methods relax these old contractures, and al- 
low a return of the flow of blood through them, and thus take away the over- 
plus which is being misdirected to the cord and, throug^h the centers, effecting 
other parts of the body. You see that the point is made that we remove le- 
sions, and that is one reason why I bring this up, becase it illustrates that fact. 
Whatever the result, according to his theory, if I correctly understand it, we 
have always stimulated, but that since we remove lesions and then leave nature 
to work, it is not an essential question to us whether we stimulate or inhibit, 
which I think is another good point, because there has been a good deal of 
hair-splitting as to whether you should give a certain twist of wrist to stimu- 
late or certain other twist of the wrist to inhibit. Now, to me. Dr. Hart's 
theory is valuable in bringing prominently to your attention this one kind of 
lesion, contracted muscle, and showing the probable effect produced. That is 
at least one kind of lesion with which we have to deal. He shows the import- 
ance which we must attach to this condition of contracted muscle, which we 
frequently find along the spine. I doubt if there will be a day in your practice 
in which you willl not find such a condition along the spine. In the criticisms 
I have to make, I do so not to criticize the article, but simply for the purpose 
of bringing out the points which I think will be helpful to you. From his ar- 
ticle I do not gather that he allows of other lesions, thouoh perhaps I am mis- 
taken. I do not think he makes it general enough. Now, I think there are a 
great many other lesions along the spine which will affect nerve centers and 
nerve distribution, and saying that contracture is the only cause of lesion is 
far from correct. So that his theory is true only when the lesion is in ilie na- 
ture of a contracture, and then I do not agree with the explanation, but I 
shall speak of that later. 1 wish to call your attention further to the fact that 



59 

we sometimes stimulate and sometimes inhibit. After you have removed the 
lesion, you sometimes have to do your Osteopathic work upon parts affected , 
and in those cases you must stimulate or inhibit. In the case of head-ache we 
frequently have to hold and, as we call it, inhibit the neck, while in the case of 
epistaxis we would stimulate the superior cervical ganglion. Then again, to 
remove the chalky deposits in rheumatism, or in absorbing an abcess, we have 
to stimulate frequently, and in that case, of course, it is not a matter of re- 
moval of lesions. Now, I have said that I think the explanation of the effects 
following contracture is only partly true, and for this reason ; I believe the 
theory is somewhat too mechanical, making this a mechanical shutting down 
upon blood supply, and thus sending an over-phis to other parts. The theory 
does not, according to my mind, take into consideration enough the mechan- 
ism of nerve distribution to the vessels and to the muscles of the back, hence 
I have gone somewhat further and have endeavored to explain the conditions- 
which would follow contractures on the basis of nerve influence. I believe 
that the generally accepted "view is that not only the blood vessels of the body^ 
but all the functions of life, are directly under the control of the nervous sys- 
tem, sympathetic or cerebro-spinal. And hence, I think it would more in line 
with the accepted theory if we could explain these things according to some 
theory of nervous influence which they have produced. Now, it is reasonable 
to suppose that there is by contracture some vaso-motor influence set up. Me- 
chanical contracture would result in stoppage of blood to the muscles along the 
spine, and would, of course, result in an over-plus of blood to the cord and its- 
meninges through the collateral branches. That would be inevitable, but that 
condition would hardly be permanent unless the vessels were dilated to accom- 
modate it, so that we must look for some sort of a nervous action to account 
for the blood remaining at that place, otherwise I believe that the blood would 
be distributed about the body, and that collateral equalization would be set 
up, and as you had anemia along the spinal muscles yon would have that much 
more blood in other parts of the body: not necessarily just along the spine. 
That is, in case the mechanical theory holds true. But I beb'eve you might 
have in such a case not only hyperemia of the cord, but you might have ane- 
mia of the cord and its centers. If the muscles contaacted and shut off the 
blood supply mechanically only, you cannot have anything but hyyeremia ; 
but if you regulate your theory according to nervous mechanism, you can have 
either. There is no question but that contractures are important lesions. For 
instance we have heart trouble caused by lesions along the back. I remember 
having heard Dr. Hildreth say that in case of weakness, general debility, ana 
irregular heart-action he always looks on the left side between the shoulders, 
looking for some contracture of muscles in that part, and that such a condition 
would usually make the patient despondent. Dr. Hildreth also said that when 
he found such a lesion on the right side of the spine it usually makes the patient 



60 

"silly;" has the opposite effect. Such is Dr. Hildreth's explanation of this 
kind of lesion alon^ the spine, and there must be some good explanation for 
the results thus produced. Now, as I have said, to me it seems very probable 
that the contractures act not so much mechanically, as through vaso-motor 
centers and fibres which they involve, and not only that, but indirectly through 
the nervous mechanism of the muscles involved. I quote from Gowers on the 
Nervous System : "The sensory nerves of muscles have been shown by Tsch- 
irjew to commence not in the muscular fibres but in the interstitial connective 
tissue." Then he goes on to explain his theory of why we get a "myostatic 
reflex action, the term he has adopted for "tendon-reflex." He says that in 
such a case the muscle is upon a tension. You remember in showing you how 
to produce the knee-reflex I crossed the knees, thus bringing tension on the 
muscles above the knee, then if you shock the muscle not necessarily the ten- 
don itself, you get the throwing out the foot. He bases his theory on the sen- 
sory nerve-endings between the muscle fibres being impinged upon by the 
fibres themselves. It seems reasonable to suppose that if the muscle is in a 
state of tonic contraction there would be a pressure upon the nerves ; and that 
is a fair explanation of the sore spots we find along the spine. Those sore 
spots have been started in a contracture 5 it has become axiomatic that we 
must look for the sore spots along the spine, and you will find that they coin- 
cide with the seat of the lesion, which is the contracture. That theory would 
account for the spot being sore, that is, providing it had not been of too long 
standing, in which case if you find it not sore you might account for it by the 
same theory — that stimulation has gone on until it is equal to inhibition. I am 
a good deal like Dr. Hildreth when he says, "If this theory does not suit you, 
figure one out for yourself," And while I am endeavoring to explain these 
things in as scientific a way as possible, if my theories are not correct, it is 
your privilege to do better. 

Now, not only would we affect the terminal sensory fibres in the muscles, 
but we know that there is a close connection between the spinal nervers and 
the sympathetics and it looks very probable that an effect might be sent from 
a muscle through its sensory terminal right through to affect the sympathetic 
nerves, and thus to affect the general sympathetic life, irrespective of any ef- 
fejt 3^ou might have through the blood supply upon nerve centers in the spinal 
cord. Thus you get the direct sympathetic effect from the irritation of sen- 
sory nerves. You remember that I quotod from Howell's Text Book a few 
days since to show that nerves were frequently stimulated through their sen- 
sory terminations in the muscles. Now, as I have said, I believe this contract- 
ure, taking: the theory that it acts through blood supply, may thus produce 
either vaso-dilation or vaso-contraction, according to the centers affected along 
the spine. I here quote from Kirke : "The vaso-dilator nerves in part accom- 
pany those first as described, but arc not limited to the out-flow^ fi'oni the 2d 



61 

thoracic to the 2d lumbar." Further: "The vaso-constrictor nerves for the 
whole body leave the spinal cord by the anterior roots of the spinal nerves 
from the 2d thoracic to the 2d lumbar." Hence, my argument is that since 
you have both vaso-dilator and vaso-constrictor centers all along the spine, 
according to the quotation trom Kirke, that acting on the center affected you 
might have either a vaso-dilation or vaso-constriction ; vou may have anaemia 
or hyperemia of the center involved. That looks reasonable to me from the 
theory of nervous mechanism of the blood supply. In case the lesion were 
such that it brought this overflow of blood upon a vaso-constrictor center, that 
center would be stimulated at first, and the first result would be to shut ( ff the 
blood to the parts affected by the contraction resulting from the over stimula- 
tion of that vaso-constrictor center. Thus you might have anaemia ; the con- 
strictor may act in such a way as to entirely shut off the blood from a part. 
Byron Robinson is authority for the statement that the sympathetics may crowd 
the blood from a part even unto death. However, suppose that the action has 
gone so far that the stimulation has resulted first in irritation, then in inhibi- 
tion, so that there is a paralysis there, then your constriction is lost; your di- 
lators are not opposed and there would be a flooding of the part; a hyperemia. 
In line with this theory I quote what Green has to say. He says that hypere- 
mia of a nerve center leads to, first, an excessive nervous excitability, together 
with paraesthesia of sight and hearing, and finally may even lead to convul- 
sions. On the other hand, if in the first place the vaso-dilator center be affect- 
ed, you would have the dilators over stimulated resulting in hyperemia, but 
when it went on, finally resulting in paralysis of those dilators, then the unop- 
posed action of the constrictors would set up an anemia, and that would be a 
permanent result. It would lead to death of the part paralyzed from the ex- 
cessive anemia of the spinal centers and the spinal nerves. Thus you get an 
effect not only upon the spine, but upon the whole distribution of that nerve. 
Thus yon can see what would be the probable effect of anemia or hyperemia of 
the cord either from this shutting down of the contractures upon the blood 
supply, according to one part of the theory. The other part of the theory be- 
ing that this contracture might shut down directly upon the nerve and through 
it send the effect to the part supplied by the nerve. Thus you see that con- 
tractures along the spine may act as stimulators or inhibitors mechanically. 
So in this case we remove the lesion for its own sake, and not simply to stim- 
ulate. 

So much for that thought. I wish to take up another question in relation to 
blood-supply, how it affects nerve life, and how, perhaps, the Osteopath may 
thus influence nerve-life through blood supply. That is perhaps getting the 
cart before the horse, according to the previous argument, still from the facts 
which I wish to bring to your attention it looks as though we might accomplish 
this. This question is not proven, but I tnus throw it out for the sake of sug- 



62 

gestion. It may lead to a good theory later. The quantity of natural, healthy 
blood in the vessels of a part act reflexly upon the mechanism, that is, the vaso- 
motor nervous mechanism, and thus affect the parts. There would thus be a 
collateral equahzation of the blood throughout the body. As I stated, the 
facts that I haye to give along this line do not strictly prove the point, and I 
have not tried to make them, but they are valuable as hints. In the first place, 
if Dr. Hart's argument be true that the effect of the blood may be stimulation 
resulting in inhibition, or that it may be inhibition direct, then the quantity of 
the blood in a part, being drawn from the spinal muscles to the centers there, 
the mere quantity of blood would account for the effect upon the nervous 
mechanism. I use the term, pure, healthy blood, because I do not take into 
consideration the question of the effect of deteriorated blood, which you know 
is a different thing. From Green's quotation we see that he considers the ef- 
fect of hyperemia upon nerve centers produces paresthesia, convulsions, etc. 
Howell's Text Book states : '-There is in some degree an inverse relation be- 
tween the vessels of the skin and of the deeper structures by the reflex mechan- 
ism of the vaso-motor centers." If superficial parts have their vessels dilated, 
deeper parts have them contracted, the flow of blood being regulated in dif- 
ferent parts of the body according to conditions. The question is, what is 
the stimulation^ There was one of our students who conceived the idea that 
the distribution of the fibres of the solar plexus upon the blood vessels close 
to the heart, chiefly the aorta, were stimulated by the flow of blood from the 
heart into the vessels: that they thus acted as vaso- constrictors or dilators, 
and thus propelled the blood, producing the rhythmic beat of the aorta. This 
student wrote to Byron Eobinson, who replied that he considered it a ^ery 
reasonable theory. Hence, you may have the quantity of blood thrown into 
the aorta acting as a stimulant. Green further notes the fact that in hyper- 
emia following inflammation, that in other parts of the body there is collateral 
anemia, because there being too much blood in one place, there is too little in 
another place. As I said, I quote these facts as suggestions, and not for the 
sake of proving the theory, but if that theory can be proven, it will be im- 
portant to the Osteopath; he may mechanically pump blood into a part, as 
for instance by flexion of the thigh, he might repeatedly flex it and j)ump 
blood into it and thus get a vaso-motor effect which is mechanical. Thus, he 
may get a nervous effect through the quantity of blood sent to the part. We 
sometimes make a pi-actical application of such a theory by working upon the 
splanchnics to reduce the amount of blood in the head; the parts governed by 
the splanchnics being a sort of a i-eservoir for an over-plus of blood, and that 
we can work it from one part to another. These facts may be taken for what 
they are worth and may be suggestions for some of you. 

n. How TO Treat a Spine, (('ontinued.) As to the second pait of my 
lecture, I shall try to conclude this subject if possibles Thci-e is one point 1 



63 

want to give you in relation to the general treatment of the spine. When 
you have acute hyperesthesia, an acute tenderness all along the spine, the 
Old Doctor treats in the neck, in the cervical enlargement, corresponding in 
general to the spines of the cervical vertebrse, and in the lumbar enlargement 
of the cord, corresponding to the spines of the last three or four dorsal and 
the space between the 12th dorsal and 1st lumbar. 

There is one treatment that I have not shown you. It is a treatment I 
have not seen any of the ladies use. It is a treatment in which the operator 
simply brings his weight to bear in this wa3^ That is what I have denomi- 
nated as the ''straddling treatment." 

I mentioned to you that we frequently get noises along the spine which 
are due to motion between parts, and in some cases that that was due to a 
slipping of parts of the ribs to their place, and when I have worked along the 
spine by getting direct pressure over one side only and I have not been able 
to produce these noises with their accompanying result, it was probably be- 
cause I did not get equal pressure upon both sides, but when I adopted this 
''straddling movement" it brought equal pressure on both sides, then I could 
get that sound and the good effect following the replacement of the parts in 
that way. 

I might call your attention to the technique of stretching some of these 
scapular muscles. You will, in your treatment of the upper part of the 
spine, either to reduce contractures or to loosen the muscles along the spine, 
find that you must stretch these scapular muscles. It is a good plan to push 
the patient's arm well down to the side on a level with the table, then, put- 
ting the hand beneath the scapula until the fingers are overlapping the spinal 
edge of the scapula; the shoulder blade has been approximated to the spine, 
there is not much space between the spine and the edge of the scapula. By 
holding firmly you can stretch that part of the muscles, so that by bringing 
the arm across the chest you bring a stretching motion upon the scapular 
muscles. By use of the thumb on the scaleni muscles at the side of the neck, 
bringing the arm up over the head, with your thumb over those muscles you 
can loosen them, this being a preparatory step to the setting of the first and 
second ribs. You must have those muscles relaxed, and you get the effect in 
this way as well. Just hold them with one hand while you push the elbow 
up toward the head and around toward the body. Those are motions fre- 
quently employed in practice. 

There is a question now as to how to reach the psoas muscle. It is one 
of the flexor muscles of the thigh. It is a good plan to simply straighten the 
legs out and then bow the back inward at the lumbar region; that gives it 
some little stretch and gets considerable of an effect upon the psoas muscle. 
The lumbar plexus is formed in the substance of the psoas muscle, and if it 
is contracted you may have trouble with that plexus. I want to show vou 



64 

one other motion which it is sometimes necessary to use, though with great 
moderation. I show is to you principally to warn you against its use. The 
patient lies on his face and you lift the legs from the table and then work from 
side to side; you can thus stretch the psoas muscle often more than you did 
before; and by working upward along the spine, one operator places his hand 
on one side of the vertebra, the other on the other; you can thus bring press- 
sure against either side of the vertebrae. This is the treatment called ''break- 
ing up the spine." It is frequently used with very good effect in cases of 
diarrhoea, flux and other troubles. The warning is that you should not raise 
the knees high above the table; if you do that and bow the back too much 
you may have serious results, and the Old Doctor has cautioned us against 
any such performance, so you must be extremely careful, though the motion 
is useful in reaching certain troubles. You might not only strain the spine 
and the anterior ligaments, but you might tip the parts of the pelvis. Dr. 
McConnell spoke of a case which had been injured in that way, and which 
has been serious ever since; he said he had found that the innominate bones 
had been slipped, and that there was an inequality at the symphasis Df the 
ndbes. 



LECTURE XII. 



I wish to recapitulate a httie in regard to the 11th lecture. At that time I 
brought up the theory of work upon a spine through the effect we could get 
by removing lesions in the shape of contracture of muscles. I referred to Dr. 
Hart's theory, which was a good one; his idea being that the contracture of 
muscles shut off the blood supply in the muscular branches of the arteries, and 
the overplus is thus thrown to the cord and affects centers and nerves, stimu- 
lating at first, but afterwards leading to inhibition. I explained how his view 
led up to that result. I then went farther and endeavored to show that such a 
process must necessarily be by affecting vaso-motor nerves, otherwise the blood 
would not be retained about the centers of the cord to influence them. And 
further, that we might have an effect not merely upon the vaso-motor nerves 
and their centers, but we might have an effect directly through the terminal 
sensory branches, running from the muscles, upon sympathetic and internal 
life. I then brought merely to your notice, without attempting to prove it. the 
point that possibly the amount of blood in a part would account for certain 
nervous eff'ects. Then again the theory of Byron Robinson, that the pumping 
of the blood from the heart into the aorta may set up a retlex action. And 
finally, the quotation from Green's Pathology that there was always a retlex ar- 
rangement of the circulation, that if the superficial vessels wore dihited, the 
deep. vessels were contracted, and vice versa; and from these and other facts ir 



65 

seemed probable that we, by working mechanically, as for instance pumping 
blood into the limb, bring a certain quantity of blood to act upon nerves, we 
eould influence nerves and centers. However, as I said, the theory is a little 
Iiard to prove. 

I. Theory of Osteopathic Work Upon Nerve Centers. (Continued.) 
— I wish to continue the same general subject to-day, going a little further into 
the question of contractures ; their occurrence, nature and cause. Now, as to 
the occurrence of contractures along the spine and in other parts of the body, 
their importance I think was fully brought out in the last lecture, in showing 
you how important they become when considered as lesions along the spine, es- 
pecially from an Osteopathic standpoint. We, as Osteopaths, find a great deal 
to say about contracted muscles, and I think we are backed by the authorities 
when we are talking about them. When we get out in practice and tell a 
patient that there is a muscle in his back or neck which has become contracted 
and failed to let go, he is sometimes inclined not to believe it, because the pop- 
ular idea is that a muscle contracts and lets go when you wish it to, and that it 
simply connot contract and hold on. You will also find that when you get out 
among the medical fraternity they will try to pick flaws m your argument, and 
unless you are backed up by authority, you hardly feel so strong in argument 
as you otherwise would. Hence, I have taken up this question a little further 
to show that what are termed "contractures" are recognized by the different 
authorities. Howell's Text Book says: "A contracture is a state of continued 
contraction of a muscle." Gower on the Nervous System says: "Tonic spasms 
persistent and involving only a certain group of muscles causes distorsion of 
the parts to which they are attached, and is termed a contracture." In the 
Journal article which I quoted at the last lecture a quotation is made from Dr. 
Allen's work on human anatomy, which is as follows: "An abnormal phase 
of tonicity is met with when a muscle sustains unduly prolonged action of its 
fibers ; under these circumstances a shortening of its belly takes place, which 
persists as long as the cause of the contraction is maintained. Such abnormal 
modification of contraction is termed contracture. Stretching of a contract- 
ured muscle is readily accomplished and maintained, provided the cause for 
the contracture is removed. Contracture, clinically considered, is a subject of 
great importance. In lateral curvature of the spine contracture of muscles will 
take place on the side of least curvature." Hence, you see that the authorities 
agree ; they say that contractures are of considerable clinical importance ; they 
say that they cause distortion of parts to which they are attached. Hence, 
you see that others besides Osteopaths attach significance to this congested 
condition of the muscle which we call contracture. But it is important, per- 
haps, in taking up this subject, to show that the Oteopath, in work upon con- 
tractures, in treating them as lesions and in removeing them, is throughly scien- 
tific and has the weight of authority and science behind him. There is a ques- 



66 

tion as to what the uature of a contracture is. We saw from the quotation 
above that Gower understood it to be tonic spasms ; then Howell's Text Book 
ssLjs, that continuous contractions may be caused by continuous excitation, and 
it regards it as a tetamis: Such a condition of a muscle may be found also in 
involuntary muscles. When you are in practice you will find that frequently in 
your work upon the intestines that they are drawn and hardened ; you will find 
the stomach hardened to the touch, and this is an abnormal tonicity which is 
regarded in the same light as contractures, although that term is not applied to 
it. You will get so that you will recognize by touch the normal feeling of the 
abdomen, and hence will be able to recognize any departure from the normal. 
Kirk is authority for the following statement: "Though involuntary muscle can- 
not be thrown into tetanus, it has the property of entering into a condition of 
sustained contraction, called tonus." Which is, as far as our purpose goes, 
practically the same thing. You will find in your work that there is quite a 
difference between the feeling that you will get from contracted muscles in the 
back and the feeling that you get when working upon the abdomen. Now, the 
external musics of the abdominal wall may be contracted as well as those inter- 
nal musles, and you will find often the outer covering of the abdomen much 
contracted and hardened. As I said, you will have to learn by experience 
what is the natural feeling of the. muscles in the back and muscles in the ab- 
domen, and how they have departed from that by becoming contracted. Then, 
again, the question comes, "Is it not exerjise that makes these muscles hard, 
particularly in the back?" Therefore, how can the Osteopath recognize the 
difference between the normal hardening of a muscle due to exercise, and a 
contraction of the muscle which is called a contracture? There are various 
ways, some of which I shall give you later m the lecture, but one way is that 
when a muscle is hardened by proper exercise it is homogeniously hardened, 
the same degree of hardness all over it ; while when you come to feel of a mus- 
cle which IS contracted, you are apt to find it raised in welts. We shall find 
the reason for that presently. Of course there is a contracture which, accord- 
ing to the definition, would be called contracture, but different from what I 
have been describing. That is in set limbs in rheumatism, and things of that 
kind, but you will recognize those readily by the case itself. 

Now, we usually find these contracted muscles not only in the back and 
abdomen, but we find them frequently in the neck, and that is one important 
place that you will have to watch for hardening of muscles. The explanation 
of the contracted muscle rising m welts on the back: When you work upon the 
back you will find that parts of muscle slip under your fingers, as if you were 
working over a whip cord or something hard ; that is what is called a welt. 
You will, of course find muscles normally contracted to produce motion. 1 
take the following quotation from Gower, which will explain itself. "Kverv 
movement is due to a contraction of a series of fibres, which soldiun corro- 



67 

sponds to the series massed together in a muscle." That is, you frequently 
have a contraction of different fibres, you might say a sort of a wave of con- 
traction running through different fibres of different muscles to produce com- 
plex movement, and he says that it is seldom that these movements are massed 
together in a muscle. Of course there are prominent exceptions to the rule, 
one being that of the biceps. He goes onto say: ''Fibres, not muscles, are 
represented in the structure of the brain, and those that cause a simple move- 
ment may be in several muscles." Bence, you see that a derangement of a 
certain part of the motor area in the cerebrum may cause a lesion of parts of 
several muscles, or a lesion of different nerve fibres of the muscles may cause 
a contraction of parts of different muscles. Howell's Text Book states: "If 
the muscle be in an abnormal state the contraction may remain localized as a 
swelling or welt." That is the term by which we usually describe those con- 
tractions. 

The Osteopath is sure of his grounds scientifically when he says to a pa- 
tient that the muscle has contracted and has failed to relax. When he finds 
that such a condition is present it is a basis of work on his part, to be treated 
as a lesion, and when he describes it as a welt, he is in accord with the au- 
thorities. 

The question naturally comes, "What is the cause ot these contractures?" 
The Osteopath regards them as peculiarly significant from his standpoint. We 
noted, in quoting from Howell's Text Book that he said constant irritation pro- 
duced constant contraction, so it must be some irritation which is continually 
acting upon the muscle itself or upon its nerve connection, causing it to act in 
this way. That of course would lead you to inquire if the irritation came through 
the symj)athetics. You will find some of the visceral diseases sending a con- 
tinuous impulse over the sympathetics through the spinal nerves to the mus- 
cles of the back. Dr. Billroth, in the article quoted from the Journal, states : 
''Contracture of muscle, is due to disease of the muscles, to primary disease of 
the nervous system, to loss of antagonism, as well as to excessive use of one 
set of muscles over another." Gowers, in speaking of nerves and muscles 
says: "The excitability is changed by disease, of which the change is often an 
important symptom." (That is, the change in a muscle or nerve is frequently 
an important symptom of disease.) "It indicates the seat of nutrition of the 
nerve fibres and muscles, and from this we can draw important inferences re- 
garding the condition of the centers." Gowers states that paralysis or abnor- 
mal excitability of a nerve refers back to the nerve center controlling it. If 
the abnormal excitability has been such as to result in contraction, it will refer 
us back to the point from which the irritation came, it may be the distant 
center or distant periphery of some other set of nerves reflected . back sympa- 
thetically. 

In discussing before you previously to this the Osteopathic view of con- 



68 

tracted muscles, I said that the Osteopath regarded them in one case as prima- 
ry and in another case secondary. Primarily, you might say, is where a mus- 
cle IS directly acted upon by some external force, some blow, strain or draught 
of cold air, causing it to contract. Your contraction then is your primary 
lesion. It will impinge upon the nerve fibres, as we saw a few days ago in 
quotations from one of the authorities, that the terminal sensory fibres of the 
of the muscles are irritated by contractures, and that constant irritation may be 
set up and carried into the system anywhere, according to the centers affected. 
This, then, would be a primary lesion. A secondary lesion would be one of 
the kind described a few minutes since, when I noted the fact that we might 
have stomach trouble producing secondarily a lesion of the muscles of the back 
producing welts ; so-called contractures. When the lesion is primary, of course 
that indicates at oace to us where the trouble is. and you, as Osteopaths, have 
learned by this time that you must go to the seat of the trouble ; even though 
you have to trace it a long way back, you will finally come to it. So that when 
you have the contracture acting as a primary cause of disease from its nervous 
connections, then of course by removing the contracture, you have removed 
that which is irritating or inhibiting. You have restored the normal, and al- 
lowed nature to take care of the balance. When it is secondary, it is a symp- 
tom, as Gowers says, of a diseased condition of a center; it may be, and so 
the Osteopath treats it. In case the diseased stomach has caused a contracture 
in the back, we could not say that by removing that lesion we have removed 
the primary cause itself. But the value of that to the Osteopath is, that he 
thereby sees where the trouble is ; it is to him a symptom, and he can trace it 
back, and aided by other symptoms, find the original cause. Not only that, 
but, according to what we have learned previously, the effect that the Osteo- 
path can have by working through nerve terminals may be gotten. He can 
work upon these lesions, which are secondary, and remove them, and he can 
thus affect the peripheral terminations. Now, if the cause works backwards 
over these nerves, then his work can reach forward along the same track, and 
he can get an effect upon the original seat of the disease. He can stimulate 
the stomach, in other words, by working along the back in the region of the 
splanchnics. Of course he would combine work upon the secondary lesion 
with work upon the original cause of the disease, whatever it was, and hi-s good 
judgment and ability to diagnose would have to tell him ^vhen the lesion was 
primarv or secondary. I recollect a case of cholera which we treated at one 
time in Evanston, which had been of seven years' standing. It was the case 
of a young lady who was some twenty years of age, and it was very bad when 
brought to us. Slie tossed about and nearly threw herself from the table, and 
it required one to hold while one treated. The lesion in that case we found 
mostly along the back on the left side of the spine; the muscles were in a con- 
tracted condition all along that side of the spine. AVe also found that the 



69 

muscles in the neck were quite stiff; we were particular to remove that con- 
gested condition of the muscles, and the cure was complete although the case 
had been of seven years' standing. It was quite a satisfactory case. Now^ 
the question is, whether that was a primary lesion or a secondary, and it is 
very hard to say. The causes of cholera are external sometimes — rheumatism 
or exposure — and in such a case the lesion may have been primary, the effect 
of exposure or rheumatism may have hardened the muscles in the back. In 
other cases it is due to over- work, worry and a whole list of different causes. 
80 it may have acted indirectly, and thus have produced those contractures. 
By working there we remove that lesion, whether it was primary or secodary, 
and we get our results. Of course we used general treatment with the special 
treatment which we gave to the lesions. M^^ chief purpose in followmg this 
line of thought was to show that the Osteopath in talking about contractures, 
in treating them as lesions, and in working directly upon them as such, is 
thoroughly scientific. As I showed you in previous lectures, he can work upon 
nerve terminals in these muscles and thus gain important results. And I think 
that an Osteopath in an argument with a physician ought not to come out sec- 
ond best. 

There is one further point which I want to bring out; and that is the fact 
that you will find flabby muscles, and when a muscle has become flabby it is 
usually an indication that the disease has progressed to a considerable de- 
gree. Very frequently these muscles have lost their tone, and our mode of 
reasoning is that we must restore life to them. I wish to state what Gowers 
has said in this regard. He says: ''That when a muscle is thus flabby, it 
shows some lesion of the nerve fibers controlling the muscle. And pathology 
has shown that section of a motor nerve of a muscle will lead to deterioration 
in the condition of the muscle. Hence, there is close trophic connection be- 
tween the nerves and the muscle fibers, so that, reasoning from that, when 
you find a flabby condition of a muscle, you must have a diseased condition 
which has advanced considerably. 

In previous lectures I have considered fully the spine, first: How to ex- 
amine it; second, how to consider the lesions found, that is, their significance; 
and third, how to treat your lesions when found. I know of no other points 
which I should bring up in that connection. I shall, therefore, go to the 
neck, and tell you of its indications. 

II. Landmarks Concerning the I^eck: — First, as Holden says, we 
note a great difference between the skin on the back of the neck, where it is 
very thick, and that on the front of the neck, which is extremely thin; this is 
the best place in the body to note that difference. The external jugular vein 
corresponds with a line drawn from the angle of the inferior maxillary bone 
bone to a point at the middle of the clavical. We find in certain heart trou- 
bles a venous pulse can be detected in that vein, we can see it from a distance. 



70 

There is a case in town in which the venous pulse can be seen in the jugular 
vein. There is also a venous hum in that vein in anemia. 

The hyoicl bone is on a level with the lower jaw; the gap just below it 
corresponds to the apex of the epiglottis; therefore any deep cut at that point 
leaves almost the whole of the glottis above the cut. The thyroid cartilege 
is familiar to you all, and you can by feeling carefully trace out both the up- 
per and lower cornua. The lateral lobes of the thyroid gland lie on each side 
of the thyroid cartilege; the bridge lies across the middle, and in that region 
you can feel the pulsation of the superior thyroid artery. The crico- thyroid 
membrane, as you know, joins the thyroid and cricoid cartileges, and that is 
the point at which laryngotomy is performed. The level of the cricoid carti- 
lege corresponds to the interval between the fifth and sixth cervical vertebrae; 
it is also the level of the oesophagus. Hence, if a child has attempted to 
swallow something too large for it, it will probably be lodged in that place. 
The superior opening of the oesophagus is usually an inch and a half above 
the sternum, but it may get as far as two and a fourth inches above the 
sternum. Normally about seven or eight rings of the trachea protrude above 
the sternum, but they are not felt from the outside, being covered by other 
structures. Surgical operations are conducted in the middle line of the neck, 
which is called the ' 'line of safety. ' ' 

III. How TO Examine the I^eck: — Of course you all know that there 
is nothing of greater importance to the Osteopath in the body than the neck. 
Dr. Harry Still is authority for the statement that almost all diseases of the 
body can be treated through the neck. Of course that is putting it very 
broadly, but it is very expressive. You can treat in the neck alone and ef- 
fect the stomach, heart, liver or intestines and you can treat, of course, in 
the neck and affect the brain, or affect the vaso motor life for the whole body. 

In the examination of the neck I have divided the subject into first, the 
throat. You all know where to find the tonsil just beneath the angle of the 
inferior maxillary bone; it is very readily felt when you want to find it, in 
cases of tonsilitis it is easily found. If you cannot find it on the outside, you 
can examine inside in the throat. So in examination of the throat you must 
always look for the tonsils if you suspicion tonsilitis. You must look for 
tender points about the throat, and where we frequently find them is, in ease 
of catarrh, just below the angle of the jaw. It is said that in every case of 
catarrh there is a tender point just below the angle of the jaw. 1 will not 
vouch for the statement, but it is made on good authority. Further, in ex- 
amination of the throat, always look to see what is the condition of the hyoid 
muscles. They are of great importance to the Osteopath — those above the 
hyoid bone and those below it; either or both may be contracted, congested, 
or drawn, shutting off the blood supply to the other parts of the head or the 
throat, causing very numerous troubles. Of coui\se you must always examine 



your patient to see that all parts are normal. You should direct your atten- 
tion first to the hyoid bone, then to the thyroid and cricoid cartileges, not be- 
cause we find them of great Osteopathic significance, but to see that every- 
thing is normal. Of course, in order to recognize the abnormal you must ac- 
quaint yourselves with the normal. The thyroid gland itself has been de- 
scribed. You should bear in mind that it may be enlarged in disease, as in 
goitre, or it may be atrophied, as in myxedema. You will be able to find it 
very readily, and you must decide whether it is enlarged or wasted, and 
therefore, you must know what is its normal size. 

You will frequently find that the lymphatics are enlarged in the neck; 
the kernels found along the course of the veins in the neck. The lymphatic 
glands sometimes become enlarged, and remain so for years, showing that 
there is some irritation or some septic process still going on. In people with 
. chronic sore throats we will frequently find that the lymphatic glands are en- 
larged, sometimes they are left so by diphtheria, or any disease which leaves 
in the system a septic product, which of course is taken up by the lymphatics. 
So you must look to see whether or not the lymphatics are enlarged. If they 
are, of course the treatment is not to them, but is to remove the cause of the 
disease. 

A further point as to the anatomy of the neck in connection with Osteo- 
pathy: you will find that the glossopharyngeal, pneumogastric and spinal ac- 
cessory nerves leave the skull through the jugular foramen. The pneumo- 
gastric runs on down just behind the anterior border of the sterno- mastoid 
muscle, and we work upon it as Ave work along the muscles in that way. 
Frequently we work upon it high up at its exit from the skull, that is, as near 
as we can get to it. We can usually bring pressure upon the nerves at that 
point. Frequently, also, we work upon these nerves through their sympa- 
thetic connection with the superior cervical ganglion. 

The phrenic nerve, as you know, springs from the 3d, 4th and 5th cervi- 
cal nerves, and you reach it at the anterior border of the scaleni muscles 
right along the edge of the transverse processes of the vertebrae. You can 
Impinge upon the nerve in that region, and you can also find the nerve, or get 
an effect upon the nerve by pressure between the sternal and clavicular origins 
of the sterno-mastoid muscle. That is where the treatment is usually given 
in case of hiccoughs. 



LECTURE XIII, 



At the last lecture under the general head of theory of work upon centers 
I considered contractures, their occurrence, nature and cause. I explained, 
according to the authorities, how these contractures happened, and that this 



72 

was the scientific definition, the term meaning continued contraction. I quoted 
from Gowers, Howell's Text Book, and others, to substantiate the point. I 
called to your mind the clinical importance that is attached to these conditions, 
especially by the Osteopath. I called to your mind their nature, that is, that 
they are called a tonic spasm, being considered in the nature of a tetanus; also 
the fact that the continued tonicity of the involuntary muscles might exist, 
which for our purpose is practically a contracture, although not called so. I 
called your attention to how you might recognize the difference between these 
conditions by the toucn. The chief points where these occur are in the neck, 
back and abdomen, as well as the limbs in some cases. I called to your atten- 
tion the fact that muscles normally contract not as a whole usually, but as sep- 
arate fibres of several muscles, according to Gowers' authority, and that ac- 
counts for the appearance of welts ; the feeling of welts under the fingers. That 
the cause was some constant irritation, some direct injurv to the muscle, or 
some exposure, or something of that kind. That is, that the contracture might 
be primary, as in the case of a blow or injury; and secondary when a muscle 
contracts due to a trouble which is far removed, as for instance muscles over 
the splanchnics contracted secondarily to the affection in the stomach, I noted 
that muscles which felt flabby were a sign that the disease had probably pro- 
gressed for some time, and that the centers and nerves were affected. I also 
called your attention to certain landmarks in the neck. To-day I wish to con- 
sider the same general subject further. 

I. Theory of Osteopathic Work Upon the Nerve Centers, Under 
THE Special Head of Further Possible Lesions. 

I have explained to you the nature of some lesions, at the last meeting the 
nature of a lesion when it is a contracture. I have also called to your mind 
other lesions, such as a slip of the vertebrae, a displacement of apart, bringing- 
pressure upon a blood vessel or upon a nerve. I believe I mentioned tumors at 
one lecture, but I shall carry that idea further at some time. Also I mentioned 
the lack of normal blood-supply being anemia, or perhaps too much blood, be- 
ing hyperemia. So that we have already considered certain lesions which may 
affect the body, may act through the nerve and cause disease. A further very 
important lesion which we frequently find in our work is a thickening of liga- 
ments following a strain or some injury. Pathology teaches us that after hav- 
ing irritation we frequently have an inflammation. That means that too much 
blood is circulated about the part, and in the natural process of inflammation an 
an exudation follows, first fluid, latter cellular, of both kinds of corpuscles. 
When this state of inflammation has gone far enough you have resulting a new 
growth. VVe know that this new growth is connective tissues or scar-tissues. 
It is vvell seen in a disease called cirrhosis of the liver, usually induced, or 
sometimes at least, by the drinking of alcohol. The alcoholic poisonino- sots up 
an inflammation. Following this inflammation there results a growth of new 



73 

connective tissues, the connective tissues normally occurring throughout the 
liver are thickened. Now, this new growth of connective tissues is all right as 
it is new and fresh and filled with blood vessles. But sooner or later the blood 
vessles begin to be contracted and absorbed and the tissue looses its blood 
supply and then it begins to contract and become pale. When that process has 
gone far enough, the contraction has acted mechanically and shut down upon 
the blood supply passing through the liver, thus the portal circulation is ob- 
structed, and the blood sets back and produces what is known as ascites, or 
dropsy of the abdomen. There you have a thickening of the connective tissues, 
you have resulting from that a condition of pressure, a shutting down ©f the 
thickened tissues upon the part concerned. In sclerosis of the spinal cord 
you have a thickening of the connective tissue either at the expense of, or fol- 
lowing, degeneration of the nervous elements of the cord. When you have had 
a wound, say a cut with a knife, you have, in the process of healing, the forma- 
tion of what is technically known as granulation tissues, this is followed later 
by the appearance of blood vessels in new connective tissue, and you have your 
scar. So-called scar tissues occur not only after cuts and wounds, but after 
abscesses and various pathological processes in the body. I wish to bring 
these things to your attention for the purpose of showing you that it is a con- 
stant and very general pathological tendency in the body to produce new con- 
nective tissue, and it is the tendency of that connective tissue when produced to 
contract. There you have something that is a very frequent source of disease, 
and it is of especial interest to the Osteopath, from his point of view, since it 
means that there may thereby be a mechanical lesion, a direct shutting down 
upon the parts. You have all known of cases where a scab has formed upon 
some external sores, catching some sensory ne^'ve terminals in its connective 
tissue, as it becomes old and commences to contract, it irritates those termina- 
tions of nerves, producing constant pain in the part. 

I wish to quote from Green's Pathology, where he says: ^'The new con- 
nective tissue is called inflammatory or scar tissue. The tendency to contract 
is cbaracteristic of this new fibrous tissue." This contraction of scar tissue 
may produce serious results." You will readily recognize the Osteopathic 
significance of anything that will contract aind obstruct the channels of blood 
or nerve force. These causes are especially significant, it seems to me, in 
relation to the spine, so I have considered that first. Now, what may the 
nature of your lesion be! As I have said before, it might be a vertebra dis- 
placed; it may be twisted or slipped, or in any way so placed as to bring ir- 
ritation upon the parts surrounding it. It makes no practical difference for 
our purpose whether first, that irritation acts upon nerves or upon blood 
vessels, just so it be sufficient to act upon the ligamentous parts about the 
vertebrae to irritate them. You will then have an inflammation. Secondary 
to this irritation you may not have inflammation, but hyperemia. Following 



74 

this inflammation yoii would naturally, according to the laws of disease, have 
a thickening of the connective tissue. I wish again to quote from Green, 
speaking about inflammations, and under the head of injuries, slight but long 
continued, he says: ''In many cases the inflammatory process ends in the 
formation of new tissue— inflammatory fibrous tissue.'' You will notice 
there that the injury may only be slight, but long continued. Such is the 
nature of a great many lesions that we find in the spine. A man comes to 
the Osteopath's office for examination. He says: "You have had a strain or 
twist here in the spine in some way." The patient says he never had any 
strain or twist there. The Osteopath- still thinks that he must have had a 
strain there. The reason why he did not know it was simply because it was 
so slight as to escape observation, and has not been attended to because 
slight, and therefore has been long continued, and finally results in some pro- 
cess of pathological growth. Further, Green says: ''If the hyperemia be of 
long duration or frequently repeated, the epithelium and connective tissue of 
the part increase." So an inflammation is not always necessary to produce 
thickening of the connective tissue, but it may occur from hyperemia. Too 
much blood about a part may, according to Green, either cause a thickening 
of the epithelium or of the connective tissue. So your lesion which has pro- 
duced nerve irritation and caused inflammation, may be slight, or on the 
other hand, may cause hyperemia, which may not necessarily be known to 
the patient. So much, then, for the tendency of these newly formed tissues 
to contract and to obstruct. From what I have already said you will see the 
significance of these things from our standi)oint, as I have already explained 
to you the effect of thickening of tendons or hardening of muscles or liga- 
ments. 

Your lesion may be not only in the nature of some slip or twist of the 
vertebrae, but, secondly, it may be a strain, a pull, a cold draft, or some- 
thing of that nature — external violence. You are all familiar with the 
phenomena which follow a sprained ankle, as we call it, and you have prob- 
ably often heard the physician say that such an injury was in some cases 
worse than a broken bone. You have, following a strain, an inflammatory 
process, and you have following that inflammatory process of course, this 
thickening of the connective tissue. Then, again, you may have a lesion in 
the nature of bad blood. If the blood is not pure, and if all of the excretory 
organs of the body are not doing theii* duty, the bad blood then acts as an ir- 
ritant and may inflame parts. Your lesion may, fourthly, be in the nature of 
some exposure, or cold, or I'heumatism. Quain, in his dictionary, speaking 
of disease of the spine, says: "The ligaments here, as in otlicr [)arts of the 
body, are especially liable to a rheumatic form of inflammation." Inflamma- 
tion means to us the formation of a new growth; a new growtli v(m> probably 
means the foi'mation of an obstruction, which of course acts as a continual ir- 



75 



ritation upon the part affected, with all the concomitant results. In view of 
the above facts, may not any Osteopath see the tremendous significance from 
his standpoint of slight, or it may be severe, sprains, slips, twists, subluxa- 
tions, injuries, exposures, and the like? Can he fail to recognize the import- 
ance of such factors in the causation of disease, or can he disregard the 
therapeutic value of their removal"? It seems that when we look at these 
things from an Osteopathic standpoint, they become fraught with great signi- 
ficance, and to my mind, nothing is more encouraging to an Osteopath than 
the thought that he can go about to remedy these pathological results. I have 
brought this up because it seemed to me that these were properly Osteopathic 
points. Hence, you will note the importance of what we have already said 
in previous lectures, that you should always and under all circumstances 
look for lesions. You should always, also, inquire into the history of the 
case. 

The method of questioning is one of the valuable means by which we 
diagnose the case, it is the only thing that leads us into the history of the 
case. 

These lesions, such as described, are of particular importance to the Os- 
teopath because you know that a contraction may cause, for instance, distor- 
tion of a part, as we frequently find in our practice. When a part has left 
its normal position it may very likely be obstructing some of the fluids of 
life, or pressing upon important parts, thus producing disease. So that the 
result of the lesions may not only be distortions but may be obstruction of 
parts; and further, they may lead to ankylosis or ossification of the parts. 
Quain' s Dictionary in speaking of Pott' s disease, says: "In the majority of 
cases sclerosis of one or more intervertebral cartileges occurs as a result of 
sub- acute inflammation; if the case proceed favorably toward a curative ter- 
mination, the destructive process becomes arrested and a healthy process is 
re-established, terminating in bony ankylosis between the bodies of the 
vertebrae; ossification also spreads along some of the ligamentous structures 
passing between the laminae, as well as between the spinous processes." 
''Thus," he goes on to say, ''the resulting posterior protrusion becomes a 
persistant deformity, a deformity essential to the cure of the disease." Pott's 
disease, I might say, is the extreme posterior curvature of the spine, also 
commonly called hunch back. Now, as to this explanation, there are several 
points to which I wish to invite your attention. In the first place, it em- 
phasizes the important of inflammation, as he says the condition may result 
from inflammation between the bodies of the vertebrae. Further, that that 
inflammation may be the result of some rheumatic process started in the liga- 
ments about the spine. Second, that the result may be ankylosis or ossifica- 
tion, if the case has gone far enough. Third, to the Osteopath it is diflicult 
to call a deformity a cure; that is what we call disease; patients come to us 



1 

I 



J 



76 

with deformities to be cured. It has been a matter of some surprise that I 
noticed that not only Quain, but others, for instance, Hilton, speak of cure 
by fixation or ossification of parts. Now, I do not call this to your attention 
to tell you that you can cure every one having ossification or ankylosis of the 
vertebrae. However, there is a kind of ankylosis that may be cured by the 
Osteopath, and that is the ligamentous form. When it has reached ossifica- 
tion, it is beyond our power. What the Osteopath is called upon to do in 
such a case, where there is fixation of parts of bony growth, is to give relief 
or perhaps strengthen the general condition of the body, which he can very 
frequently do. The peculiar work of the Osteopath, in cases which are pro- 
ceeding to such a termination, is not that he may remove the ankylosis or 
the ossification, but that he may prevent its forming. I think our practice 
justifies the statement that he can prevent such things. A great many cases 
of spinal curvature have been cured out- right, and there is no telling what 
the termination of such a case of spinal curvature may be. However, they 
might have gone on to ossification or ankylosis of the joints. The simple 
facts are that cases of deformity have been saved from being parmanent, and 
that people have been saved from the lives of cripples time and again by Os- 
teopathic therapeutics. And S5 these things are significant to us more in a 
prophylactic light, that is, that we may prevent their growth. 

For examples of the general cause of disease following a slip or strain, 
which has resulted in a thickening of ligaments, I wish to note several cases: 
I have had cases in which, along the region of the splachnic nerves, there 
was a tightening of all the ligaments, the parts of the spine being approxi- 
mated. The result of that lesion was some form of stomach trouble. I have 
seen a case of neurasthenia, which I would attribute to such a cause. ^\Tien 
practicing in Chicago we had a gentleman who was in rather a remarkable 
condition. His general trouble might be described as neurasthenia. His 
trouble was largely circulatory and nervous. He had a skin as soft as a 
baby's almost; a ruddy complexion; looked strong and healthy, and one 
would hardly think there was anything wrong with him. But he said he 
would at almost any time break out into a perspiration, when there was not 
any heat at all or exertion to account foi* it, or perhaj)S he would be chilly. 
Then, again, he would flush up following any exertion. He would have 
trouble with his head, and could not work at times. At times he would be 
bothered with sleeplessness. Now, those were general nervous troubles and 
troubles of the circulation- He was a man, who, on account of his disease, 
led practically an outdoor life. The lesion in his case, according to our ex- 
amination was along the spine. We found that the ligaments along the spine 
seemed to be tightened, and that the muscles were contracted. Now, ^vhether 
or not the theoi'y fits the facts, and whether or not all thesc^ things are 
brought out properly, it seems to me they explain, at least theoretically, what 



we do when we meet similar eases and go to work to remove sucli lesions. 
Such lesions then, may come, first, by direct impingement and irritation of 
the nerves. As, for instance, where they emerge from the spine at the inter- 
vertebral foramina. Second, they may act through the blood supply, as was 
shown in a lecture or two since, by causing anemia or hyperemia of the cen- 
ters or the nerves. This hyperemia or anemia may be collateral on account 
of the condition of the circulation to the spinal muscles, or the anemia may 
exist directly by pressure at the intervertebral foramina on the anterior and 
posterior spinal branches, or perhaps pressure in the same way on the 
vertebral branches of the arteries, and thus shutting off of the blood supply 
to the cord. 

II. Landmarks Concerning THE Neck : — Holden notes the sternomas- 
toid muscles, which he calls the surgical land-mark of the neck, and calls to 
our attention the fact that it stands out in relief when acting to turn the head 
toward the oposite shoulder. Behind its inner border lies the pneumo gastric 
nerve, in the same sheath with the common carotid artery and the internal 
jugular vein. The common carotid artery runs as far as the upper level of the 
thyriod cartilage, where it branches into the internal and external carotids ; its 
course corresponds to a line drawn from the sterno-clavicular articulation to a 
point midway between the angle of the lower jaw and the mastoid process. 
Note the interval between the sternal and clavicular origins of the sterno-mas- 
toid muscle. Just behind this interval lies the common carotid artery inter- 
nally, the internal jugular vein externally. Between them, and a little poster- 
iori}^, lies the pneumogastric nerve. The sterno-clavicular joint is important. 
Behind it lies the commencement of the vena innommata. It is the level of the 
division of the innominate artery on the right, and the level of the apex of the 
lung. As to the apex of the lung, it may rise one and a half inches and perhaps 
two inches above the suerno-clavicular joint. This is the point of the lung 
which is least apt to be inflated with air, and hence very apt to be the seat of 
disease. I have already called your attention to its examination by percussion 
at the sternal end of the clavicle. The subclavian artery is also important. In 
the supraclavicular fossa, just at the outer edge of the sterno-mastoid muscle, 
about an inch aboye the clavicle you will feel the pulsation of the subclavian 
artery ; at that point it crosses the first rib. Pressure slightly downward and 
inward there will impinge upon the subclavian artery; a little pressure is suf- 
ficient. As you know, the outer border of the sterno-mastoid muscle corres- 
ponds nearly to the outer border of the scalenus anticus muscle, and that across 
the scalenus anticus runs the phrenic nerve. Now, at about the point where 
you impinge upon the subclavian artery you will also reach the phrenic nerve. 
In fact, the way Dr. Harry Still often treats hiccoughs is by standing behind 
the patient and placing his thumb along the outer edge of the sterno-mastoid 
muscle and thus reaching the phrenic nerve. Deep pressure at the upper part 



of the supraclavicular fossa will reach the transeverse process of the seventh 
cervical vertebra. Id a long thin neck it is stated that just above, and nearly 
parallel with the clavicle can be felt the posterior belly of the omo-hyoid mus- 
cle, as it rises and falls in inspiration. 

III. I wish to contine the examination of the neck. There were a couple 
of points that I should have noted in going over the spine, but they slipped my 
mind at the time. One of them is how to stretch the quadratus lumborum 
muscle. This muscle in various cases will become contracted and will then 
draw down the lower rib, and may make considerable tronble. I have found 
that I coud treat a lame back in that way and get results that I could get in no 
other way. Frequently the lameness there is between the fifth lumbar and the 
sacrum. And why? Because the traction in the quadratus lumborum muscle 
is drawing the pelvis up and is bringing a strain at the point of junction of the 
fifth lumbar with the sacrum. I have often removed lameness there by stretch- 
ing that muscle. It takes a diagonal pull to stretch the quadratus lumborum 
properly. If I have an assistant I have him draw on the pelvis while I draw 
the arm in the other direction. I draw steadily, but do not jerk, and I put a 
considerable force of traction upon the part. Then I have my asssitant take 
the arm, and I stretch in the other direction, and in that way get a pull upon 
every part of the quodratus lumborum muscle. 

The other point concerning the spine was, that you will in running your 
hand over the back frequently detect changes in temperature. You will find a 
warmer spot, or, more frequently a cold streak following the distribution of 
the inter-costal nerves. That is quite an important method of diagnosis. You 
should accustom your hand to detect differences in temperature. Of couse that 
has to be done next to the skin. When you find that, of course it indicates at 
once that the blood supply is not equally distributed, and that probably there is 
a lesion along the spine at the point where the cold streak leaves it. If you 
find it hot it may mean the same, but we do not find that as often as we do the 
cold streak. 

In the consideration of the neck I have divided it into, first, the throat, 
which I considered at the last lecture ; second the neck proper, which I shall 
consider at this time. I have already noted the spines and peculiar vertebrae, 
and the fact that you can note the dislocated vertebi'a sometimes by an exami- 
nation in the pharynx by means of the finger. I have called the atlas to your 
attention and the fact that you must turn the head from side to side in attempt- 
ing to examine the transverse processes of the vertebrae. In a case of fracture, 
which we may possibly find, there will be crepitus and abnormal mobilitv of 
the parts. You should in your examination of the neck li>ok at the con- 
dition of the superficial and deep muscles. Carefully examine to note any 
hardening of the muscles. The hardening, of course, may be in the supertlcial 
muscles or in the deep muscles; you will have to judge as to wiiere you tlunk 



7& 

the tigbtening' of the muscle is. Examine very carefully all about the super- 
ficial and the deep muscles. It is usually in the throat that you find the super- 
ficial muscles contracted aud the deeper ones in the neck further back. The 
sterno-mastoid muscle of course always comes prominently to your attention. 
It is contracted in cases of torticollis ; or it may be hardened and produce pres- 
sure upon the structures beneath it. Then examine the scaleni muscles. You 
know how they are attached, reaching all the way from the second cervical 
dovvn to the seventh and then running- to the upper two ribs. Normally these 
muscles will feel rather hard, you will become acquainted with the normal feel- 
ing of them. They are significant to us from the fact that they sometimes be- 
come contracted and bring traction upon the upper two ribs. Hence it is that 
any displacement of these upper two ribs is very likely to be upwards. This 
will cause heart trouble, or lung trouble, etc. These muscles are useful in re- 
placing ribs which are dislocated. I have already noted the ligamentum nu- 
chae 5 how you may find it and how you may treat it. The neck is about as 
good a place as there is for the Osteopath to find sore spots. Principally you 
are liable to find them in the fossae just below the occipital bone. In fact I 
have been told that it is always naturally sore there, but I don't believe it, be- 
cause I find lots of cases that are not sore there at all, and I think that in the 
normal neck there is no soreness there. Of course you may impinge at any 
time upon a nerve hard enough to hurt it, but I am speaking of examinations 
not of chopping wood. Why these sore spots occur is hard to say, but I think 
the soreness is due primarily to the condition of the great and suboccipital 
nexves which you find at that point. I do not think that it is just because you 
touch them, but they were sore before you touched them. Then you will often 
find that just below the occipital protuberance there is a sore spot, and just 
there you will often find a tightening of the ligaments. The lesion is irnpor- 
tant because if you find a sore spot there or in the fossa below the occipital 
bone you are led to believe that there is some irritation affecting the sub- and 
great occipital nerves, and since they are in close connection to the superior 
cervical gangion of the sypathetic they may have an affect through it upon the 
distant parts of the body. You should also examine in the region of the three 
ganglia of the sympathetic. The superior cervical ganglion lies opposite the 
second and third vertebrae on the scalenus anticus muscle. The second cervi- 
cal ganglion hes opposite sixth and seventh cervical vertebrae. While the in- 
ferior cervical ganglion lies just below the seventh cervical vertebra, and is 
frequently coalesced with the first thoracic ganglion of the sympathetic. Quain 
puis it that this inferior cervical ganglion of the sympathetic lies just over the 
costo-central articulation, that is, the articulation of the first rib with the spine. 
Now, if you should find lesions in those places they are, of course significant to 
you according as they may affect the sympathetic life of the individual. They 
may affect the brain, heart and lungs, or any distant part of the body. Also 



80 

remember the distinctly spinal nerves here, those of the cervical and brachial 
plexuses. Impinge upon these nerves where they pass oat between the scale- 
nus medius and scalenus anticus muscles and upon deep pressure the patient 
will tell you he can feel pain in his shoulder and arm. You should also here 
lools: at the temperature of the parts you are examining, and I think that no- 
where else in the body we as frequently find a cold place as in the back of the 
neck. I thought perhaps it was because it was more exposed, but I doubt that 
very much because I have treated patients who had been in the house for hours 
and those muscles were cold. I have treated patients in the heated period of 
summer when certainly there was not any chance of there being exposure to 
cold, and the temperature was abnormally low. That argues to your mind 
certainly that there is some inequality in the distribution of the blood flow, it 
may be a tightening of the muscles upon the blood vessels, but it shows you at 
any rate that there is probably the seat of the lesion. In relation with this ex- 
amination you must look at the condition of the blood supply to the throat, 
through the neck and thus to the brain, which is important, and you should be 
very sure that the blood supply to the neck and brain are normal. 

Q. You spoke of treating the phrenic nerve above the clavicle. Could it 
not also be reached from the second to the fifth cervical ? 

A. Yes sir. Dr. Harry Still frequently works right along the third, 
fourth and fifth cervical. The phrenic nerve arises from the fourth, also part- 
ly from the third, and having a connecting branch from the fifth. So we get 
work at the anterior edge of the scalenus medius and impinge upon the nerve 
by pressing backward against the transverse processes of the vertebrae. 

Q. Do you use the word lesion for any abnormality about the body! 

A. I have used it for an injury. Taking it in its generic sense it means 
injury. There is a difference, perhaps, in the use of that word, but we here 
use it in the sense of an injury. That is the use I have heard made of it ever 
since I have been here. I believe the books define it as some abnormality of 
the tissues. 



LEOTUEE XIV. 



At the last lecture I considered briefly possible lesions of centers. T 
shall carry that idea farther to-day. What I took the most time to explain 
was how thickening of connective tissue of parts might lead to impingement 
upon blood vessels or upon nerves, showing that, in the first place, thew 
might be an irritation caused by a slip of a vertebra, thus setting up inllaiu- 
mation, this followed by formation of new tissue which has a tendency to con- 
tract. I show^ed that the same thing could follow hyperemia. Such things, 
then, are significant to tiie Osteopath, since they act as obstructions to the 



81 

flow of blood and nerve force. Snch lesions may, if not prevented, go much 
further, resulting in bony ankoylosis of joints or in ossification of ligaments, 
thus setting up a permanent deformity. It is then the function of the Osteo- 
path not so much to treat that deformity, as to prevent it. That is, in such 
case his treatment is prophylactic. 

I then called your attention to landmarks in the neck, and to certain 
points in how to examine the neck. 

I. Theory OF Work Upon Centers. (Continued.) — Further possible 
lesions. You may have a pressure upon important parts by exudates or by 
oedema. An exudate is in the nature fluid or cellular, and it follows patho- 
logical processes in the nature of inflammations or hyperemia. Having an 
inflammation, you have an exudation of the contents of the blood vessels; 
those contents are fluid, or in the later stages of the exudation, cellular. They 
thus may, at any place, and do, build up a considerable thickening among 
the tissues, acting as a mechanical pressure or irritant upon important parts. 
These important parts may be blood vessels or nerves. Byron Eobinson says 
'iThe nerves may suffer from pressure by exudates or oedema, congestion or 
from malnutrition. The final outcome is derangement of the nerves, exalta- 
tion of sensation and motion, or debasement of sensation and motion.'' He 
was speaking there particularly of the nerves to the bowels. The Osteopath's 
duty in relation to such things is that he must, in making his diagnosis, take 
into consideration the probability of there being such a lesion present. You 
will, of course, in your further studies which will include pathology and 
other important things, learn how to recognize these lesions better than I can 
tell you here. What I propose to do is to use these things to illustrate the 
subject of Osteopathy, but I cannot of course go into detail and explain every- 
thing in pathologj^ that I come across, but they are "valuable to you, and you 
will recognize their importance when you come to that place in your course. 
In general, you will recognize or look for the process of oedema in patients 
with lung, kidney or heart trouble, you will be very apt to find it in such 
cases; or in cases where there is obstruction to the blood flow. It may be 
mechanical shutting down upon an artery, or it may be a narrowing of the 
lumen of a vessel from some disease, or something of that kind. The Osteo- 
path must judge what may be the cause and work to remove the lesion. As 
to hyperemia, and its effects upon the cord, I have already shown this to you 
in a quotation from Green some time since, where he said it caused paraes- 
thesia of sight or hearing or perhaps even spasms. But according to Eobin- 
son, this hyperemia may act mechanically to affect not centers only, but di- 
rectly to affect nerves through pressure. Your lesion may be malnutrition, 
but I will notice that later. Other lesions which may produce pressure upon 
important parts are deposits or growths. I wish to quote from Dr. Jacobson, 
Dr. Hilton's editor, where he says: ''Sensations of sharp pains like knives 



82 

aroimcl tlie trunk, increased by movement, and a numbed feeling about the 
body, may be produced by gummatous meningitis making pressure upon the 
posterior roots of some of the spinal nerves." You note here that the 
pathological process is an inflammation, that secondarily there is set up a 
pressure as the result of that inflammation, which is a gummatous deposit, 
thus it acts as a lesion producing i)ressure. Hilton instances a case, further, 
where there was pressure upon the ulnar nerve, causing much numbness, 
lack of sensation, and particularly of motion, in the third and fourth fingers. 
They became discolored, and finally gangrenous. (Gangrene is death of tis- 
sues. ) Upon examination there was found an exostosis, an outgrowth from 
the bone, upon the first rib, pressing upon the ulnar nerve and the subclavian 
artery, thus shutting off the nerve and blood supply partly, the nerve more 
fully. However, shutting off the nerve supply alone would have been sufficient 
to cause degenerative changes in the part affected. 

I wish to call your attention to this structural degeneration by pressure 
upon a nerve. Thus, you may have pressure in the form of a foreign growth 
or in the form of some excrescence upon important parts. Further, your 
lesion might be an aneurism, and it might bring pressure upon parts. Green 
states that active congestion follows pressure upon the sympathetic, as for 
instance in the neck by an aneurism. Thus you may inhibit vaso tonic action 
of the sympathetic and cause hyperemia, or vice versa. Another kind of 
lesion which will frequently come to your attention is tumor, which you will 
notice also is of such a nature that it produces pressure upon important parts. 
You might take, for instance, the case of ex- ophthalmic goitre; there you 
have protrusion of the eye ball due to a deposition of fat behind it. That 
shows an over stimulation of the trophic fibers to that part of the head. There 
are also cardiac symptoms, palpitation and irregularity in the beat of the 
heart, which shows an interference with the cardiac nerves, the sympathetics 
receiving pressure from the goitre in the neck. And further, you have vaso 
motor symptoms from the pressure of this goitre, because you frequently have 
a flushing up of the cutaneous circulation. This is a good example of what 
mechanical pressure may do to influence nerve life. Robinson also instances 
the case of an abdominal tumor leading to fatty degeneration of the heart. 
The impulse sent from the tumor up along the abdominal sympathetics to the 
solar plexus, here it is reorganized, perhaps sent to the cervical sympathet- 
ics, down the cardiac branches to the heart, resulting in irritation of th(^ 
heart, causing the heart to over feed itself, which finally results in hyper- 
trophy, followed by fatty degeneration. Thus you can leai-n to trace the 
causes. Almost any young Osteopath would treat that effect, lieart trouble. 
when really it is the tumor, far removed from the heart, wliich is the caust^ 
of the trouble. In speaking of abdominal tumors, Kobinson says: "Their 
Vitation from the tumor is carried on the plexus of any contiguous viscus lo 



83 

the abdominal brain, where it is reorganized and emitted to the digestive 
tract over the gastric plexus, the superior mesenteric plexus and the inferior 
mesenteric plexus. In any case the brunt of the forces end in the ganglia 
which lie just below the mucous membrane. The ganglia CDustitute what is 
kQOwn as Meissner's plexus, which rules secretion. If the irritation be of 
such a nature as to produce excessive secretion, diarrhea may result; the ex- 
cessive secretions will decompose and induce malnutrition." Thus one dif- 
ficulty leads to another. You might have constii)ation, indigestion and vari- 
ous troubles. He goes on to say that small tumors on pedicles so that they 
may swing around, and roll about, and pound upon the abdominal structures 
are those which are most injurious, for obviously, if the tumor is fixed, it 
will not irritate much, but if it rolls about and is quite movable it will keep 
irritating the sympathetics and aggravating the trouble. 

The lesions given above are the lesions which produce pressure in the 
body, pressure upon important structures, for the most part nerves. I have 
already in my lectures noted certain results that you would get from pressure 
upon nerves, for instance, irritation, stimulation, inhibition, hyperemia, 
anemia, etc. But I wish to go further to-day and show that the result may 
be more serious than a mere inhibition or stimulation, that it may lead to de- 
generation of the nerve fibers. Thus there would be processes of deteriora- 
tion of the structure of the parts, especially of the nerves affected. The pro- 
cess of degeneration of the nerves is about as follows, and is called secondary 
degeneration, since it is secondary to some primary lesion; it is also called 
Wallerian degeneration. The first process is that the myelin becomes de- 
generated, the sheath of Schwann becomes separated into parts, still later it 
becomes granulated, and finally disappears from the nerve sheath, perhaps 
by the process of saponification, as has been stated by some writers. During 
this process the axis -cylinder, which is the important part of the nerve, is 
segmented, broken down and removed in practically the same 
way. Thus you finally have nothing but the nerve sheath 
left. The nerve has then lost its conductivity and is useless 
as a nerve. What I wish to show is that pressure upon nerves may be 
bad enough to induce this degeneration, which you can readily see is a serious 
result. Gowers says : "Degeneration follows many slight lesions of nerves, 
compression, overextension, and the like." He says further that it is proba- 
ble that a compression for a few hours has such an effect in separating the 
molecules in the white substance of Schwann as to set up a secondary degener- 
ation of the same character as that resulting from division of the nerves. This 
pressure does not need to be severe ; it may not extend over a period longer 
than a few hours to -produce finally all the results which the Osteopath meets in 
his work. Pressure of some dislocated part or pressure of some such lesion as 
I have mentioned to-day upon nerves, interferes with the sense of feeling and' 



84 

with structure of other parts, and may have a similar effect to cutting the nerve. 
Gowers says that after division of a nerve or degeneration of its fibres, there is 
a marked change in the muscles supplied by the motor nerve. This is a change 
which is a deterioration of their structure. 

So much, then, for lesions which may be brought on by pressure. You 
have seen from what I have said what this pressure may result from. I wish 
to call your attention to the fact that the action of muscles may in certain cases 
become traumatic, wounding a nerve, and setting up serious results, often de- 
generation. Gowers, speaking of neuritis, says: "Nerves are sometimes dam- 
aged by a violent contraction of a muscles through which they pass. It is prob- 
able, also, that muscular action excites neuritis in other situations, especially 
in persons who are predisposed." Also we may notice the indirect result of 
traumatic lesion by action of the muscles. 

Bryon Robinson, in speaking of peritonitis, says: ''Peritonitis is due to 
two causes, (of which I will name one.) viz., trumatic muscular action of the 
psaos magnus on the sigmoid, and trumatic muscular action of the lower right 
limb of the diaphragm on the descending colon." The way by which the nerves 
there are involved is this : That that injury allows the migration of patho- 
genic bacteria, which set up peritonitis, thereby crippling the nerves, and per- 
haps causing considerable degeneration of them. And this traumatic lesion, 
directly by action of muscles upon nerves, or indirectly as in this case, is an 
important thing to the Osteopath, and he must take it into consideration in di- 
agnosing his cases. You will learn later that these nerves when degenerated, 
may, by appropriate treatment, of which rest and quiet is an important part, 
be regenerated. 

To illustrate the results of pressure, take a case of which Dr. Hilton 
speaks ; being a case of fracture of the radius. The callous in the growing to- 
gether of the bone had pressed upon the ulnar nerve above the wrist, and 
there had resulted, not a paralysis, but an ulceration upon the skin of the 
thumb and first and second fingers. He also notes a case in which pressure of 
the humerus upon the brachial plexus has resulted in a wasting of the deltoid 
muscle by insufficient nerve supply from the circumflex nerve, which had been 
impinged upon. That emphasizes the importance and necessity of taking into 
consideration everything which may bring pressure upon parts. 

Your lesion, as I have stated, may be malnutrition. I have already ex- 
plained that to some extent. Amenia may not only affect centers in such 
cases, but it may affect nerve fibres directly, or the malnutrition may be from 
a poor quality of blood. 

The question comes to you, what can an Onteopath do in such cases: 
Can he remove exostosis, anuerisms, and such things as thatf No. he c-aw not. 
If you have a case of exostosis, it is a surgical case and you will have to scud 
it to a surgeon. Aneurism has usually to be treated by surgical means. 1 



85 

have called these things to your attention on account of their importance, and 
to lead you to be upon your guard. You should not take secondary symptoms 
and treat them. Be on your guard always in making your diagnosis. Some 
of these lesions you may remove of course, such as the exudates in hyperemia 
or inflammation, or the gummatous tumor in meningitis. also the goitre pressing 
upon the sympathetic. All these things are subject to your treatment. 

II. How TO Treat a Neck: — I have called your attention to how to ex- 
amine the neck. I wish to say to you that it is an extremely important thing 
that you treat the neck carefully, for the treatment of the neck, more than any 
other part of the body is to be done with great care by the Osteopath. As in 
the consideration of the examination of the neck, I first take up the throat, so 
in the treatment I will notice that part of the subject first. In treating the 
throat your first duty is almost always to note whether there be a contraction 
of the hyoid muscles, and if such be the case to relax them, as that leaves a free 
field in which to work, since they may mask other troubles which you may not 
notice without having that removed first. Your tehnique of manipulation must 
be carefully noted, and the degree of force which you exert, because there are 
important structures which you may injure by rough pressure. The best way 
is to use the flat of the hand ; the cushions of your fingers. To relax the mus- 
cles here the best way is to push the head toward the side, that is away from 
you, while drawing the other hand toward you. You do not have to rub your 
fingers over the neck as though your fingers were a file, as some people's fin- 
gers are. Draw the muscles with the fingers, do not let them slip over the sur- 
face, but hold against the muscles and draw them toward you. You can do 
this work as thoroughl^^ as possibe without any rough rubbing at all ; necks are 
readily chafed sometimes, and if you wish to save the patient to your practice 
3'ou will have to be a little careful how you handle his heck. 

Next as to the tonsils. When you find an enlarged tonsil and wish to 
treat it, the first thing to do is to loosen the muscles over the blood supply to 
the tonsil, which is from branches from the carotid arteries. Hence, if you 
have relaxed all the muscles about the tonsils both internal and external, so 
that there is no further inpingement upon the blood supply then you have re- 
lieved the lesion. Of couse if the lesion is back in the neck causing the nerves 
to shut down over the vaso-motor supply you must attend to that. However, 
generally we work directly in this way. Give it a thorough treatment, but not 
too hard. Work along the angles of the jaw, and then work all down along 
the course of the common carotid artery, down as far as where the artery comes 
from the thorax just behijad the edge of the sterno-mastoid muscle. That 
should be done thoroughly ; you should not be m a great hurry. Further, I 
always put my fingers in behind the clavicle ; be careful in putting your fingers 
there not to hurt, because it is a very tender point. I always put my fingers 
in there, then approximating the bent arm to the face press it on above and 



86 

over while my fingers lie between the clavicle and the first rib. This relaxes 
everything' ; then bring the arm down over the head, outward and downward ; 
this will stretch the parts and stimalate the flow of blood through the carotid 
artery. Perhaps the chief value of that movement is this: We frequently find 
that the muscles about the upper part of the thorax are drawn and are making 
some impingement upon or stoppage of the blood flow through the carotid arte- 
ry, and you simply give it freer action by the motions you use there. We also 
frequently stretch the jaw. as we call it. I put my fingers just below the in- 
ferior maxillary bone, placing the thumbs above, usually about the molar pro- 
cess, then holding fairly tight spring the mouth open, rubbing downward as 
the mouth opens to relax the muscles. That should be done three or four 
times. It is not a bad idea to simplv hold the jaw firmly and tell the patient 
to open the mouth while you are holding, and that will stretch the muscles 
about the part. Of course, in treating any part you must watch its blood and 
nerve supply. We have mentioned the blood supply m this instance. The 
nerve supply is from the pneumogastrie and from Meckel's Ganglion of the 
filth. You cah stimulate the pneumogastrie at its exit from the skull by deep 
pressure. You can also get an effect npon Meckel's ganglion by having the 
patient open his mouth, and thrusting the gngers into the glenoid fossa, have 
him close it again. It will usually hurt, but it is supposed to have an effect 
upon Meckel's ganglion, which I will show later when I tell you how to treat 
the neck. The point there is the communication of the sympathetic with the 
pneumogastrie and with the Fifth and with the blood supply about the tonsils. 
Thus you have treated both the nerve and blood supply in treating an enlarged 
tonsil. If your diagnosis has shown you a tender point just below the angle 
of the jaw, as is stated to be the case in catarrh, the best way to attend to it is 
by the means already given, viz., relaxing all the parts. In that way you will 
throw fresh life there and take away the pain and tenderness. 

Should you find lymphatic glands enlarged it is a mistake io go at them 
and treat them directly. If they are enlarged it is from some ri^ason. Y\)ii 
will sometimes find them enlarged in tonsilitis or in diphtheria, and tliey are 
enlarged because they have work to do scavengers, and you must look to the 
original cause. I do not think it admissable ever to work directly upon those 
lymphatics, thinking that that will take down the enlargement, especially in 
acute cases. It may possibly do in chronic cases, but in acute cases I have 
known of injury being done by rough treatment of enlarged Ivmphatic glands 
when the trouble was somewhere else. 

Q. In the case of tonsilitis would you not stimulate the blood awav from 
the tonsils"? 

A When you have stiuuilated tlie arterial supply, you will sweep ;nvM\ 
the. congestion. Whenever you have attended to th^^ nerve supply there regu- 
lating the blood, the vaso-motors, of course then you get the same egect. it all 



87 

tends toward the normal and to restore the circulation as it should be. 

Q. Increasing the arterial flow will sweep away the condition ? 

A. Yes, that is the tendency, that is how you can affect congestion 
through blood supply, but do not forget to couple it with nerve supply vaso- 
motor. 

Q. I thought the way to get at it was to drain the congested part by 
venous withdrawal. 

A. That comes partly through your vaso-motor effect, but if you can get 
sufficient vis a tergo from behind to sweep that all out, that is all you need, and 
that IS readily done. 

Q. Do you always have a local edematous condition with inflammation ? 

A. I do not know that there can be an inflammation without edema — with- 
out an exudation ; that is one of the important symptoms of inflammation. 

Q. Do you treat the sympathetics for goitre? 

A. The cervical ganglion, all three of them I would treat, but would es- 
pecially direct my attention to loosening the anterior and posterior muscles, 
with the idea of relieving all parts and allO'Ving a free flow of blood and nerve 
force. Of course you must do here, as you always do, look for the Ihsion. 
You may find the clavicle is slipped, or you may find that one of the vertebras 
-i& displaced — it depends upon the cause. 



LECTUEE XY. 

At the last lecture I considered, under the general subject of theory of 
work upon centers, further lesions that you might meet in your work. That 
you might have pressure by exudates or edema; that the exudate might be fluid 
or cellular ; that the Osteopath must take into consideration the possibility of 
such lesions and be on the lookout for them, thus going into the history of the 
case. For instance, if there is a history of inflammation, you will look tor 
such a possible lesion, or if a history of congestion, you will look for that 
lesion. The lesion may be a congestion bringing pressure upon parts, or it 
may be malnutrition ; it may be some kind of a deposit, as for instance a gum- 
matous deposit, of which I instanced a case ; the pressure of the gumma upon 
the posterior roots of the nerves, where they emerge from the spinal column. 
I spoke also of an exostosis, or growth froma bone ; the lesion may be an aner- 
ism bringing pressure upon the sympathetics ; or it may be some kind of a tu- 
mor, as in the case of exophthalmic goitre. I then quoted from Robinson to show 
what the effect of such lesions might be. I went farther to show that the re- 
sult might be more serious than mere stimulation or inhibition of nerve force, 
showing how it might cause actual degeneration of the nerves and paralysis of 
the parts supplied. I showed you how such degeneration might be accom- 
plished by the traumatic action of contraction of muscles. That although the 



88 

Osteopath was not able in every case to remove these lesious, he may prevent 
their formiD^, or he may be able to recognize the presence of such lesions and 
send the patient to a surgeon if the ease required surgical interference, without 
himself bothering with them. 

I. General Considerations. 
There is a question that sometimes arises in the mind of the Osteopath, as 
to what the effect of stimulation or inhibition will be upon parts which he is 
not attempting to affect, but which are connected directly or indirectly with the 
parts on which he is working. In other words, will he thus stimulate or inhib- 
it other important paths of nerve force, and thus, you might say, set up a path- 
ological result, and his treatment result in certain pathological processes which 
were not intended? Every once in a while a patient will say to you, such and 
such a thing happened after your last treatment, and do you think that your 
treatment could possibly have lead to such and such a trouble ? If you are 
perfectly sure that the action of your treatment upon surrounding parts is not 
such as to produce pathological results, you will often be able to answer him 
strongly in the negative, when otherwise he would think you to blame for 
something that happened. You will frequently meet cases of that kind. I 
have had a number of such questions asked me. When considering probabil- 
ity, remember that the tendency is always toward the normal, and that helps 
you much, unexpectedly as well as expectedly sometimes, not only where you 
remove a lesion and depend upon nature to tend toward the normal to restore 
things as they should be, but that the manipulation that you make upon an af- 
fected part tends to restore that part to normal, while a manipulation that you 
make upon the parts associated does not tend to the abnormal of those associat- 
ed parts at all, but that the effect upon them is simply what might be com- 
pared to the effect of normal exercise. So that you need not be afraid of pro- 
ducing pathological results in that way. For instance we have to treat the 
pneumogastric in a case where the liver is not acting properly, and the intes 
tines seem to be lacking in stimulating force. Part of our treatment in such a 
case would be directed to the pneumogastric nerve, since it has to do with these 
viscera. Now, the question is, w^hether by stimulating, or inhibiting, or treat- 
ing those nerves you would also have an effect upon the lungs and heart, which 
are supplied by the pneumogastric nerves, an eifect which would be bad. Such 
has not been the experience at all, and you are not in danger, in treating [he 
pneumogastric in such a case, of having a bad effect upon the heart and lungs, 
supposing them to be normal, because your treatment tends to restore the ab- 
normal intestine and liver to the normal, while it tends simjily to have the ef- 
fect of exercise upon the other parts, and tliere is certainly nothing bad in that. 
Again, you might have a case in which the s[)lanclinics were involved, and one 
who was very careful over questions of theory might want to know whetlier 
treating those nerves would have a bad effect upon tlie kidneys. Kxpenenct' 



89 

shows that such would not be the case. Or, for instance, in the case of eye 
trouble, you very frequently find that the terminal branches of the fifth nerve, 
emerging from the supra-orbital foramen, are very tender to the touch, proba- 
bly on account ot a secondary lesion there, abnormal impulses coming from 
that nerve terminal causing the parts about the foramen to contract and im- 
pinge upon the nerve, thus keeping it tender. That may be the cause of it. 
Now, of course in treating there you simply remove the contraction about the 
parts, you stimulate the blood vessel there, and the nerve, and remove the sore- 
ness, and you would not be afraid of interfering with the nutrition of the eye, 
which is innervated by the fifth nerve. This will serve particularly to explain 
the effects obtained by those who are not entitled to the right to practice Oste- 
opathy, certainly of those who have seen the pecuniary benefits of Osteopathy 
and have gone out without proper equipment, and have become what the "Old 
Doctor" calls "engine wipers," and I presume others who have had better op- 
portunities may work in the same way. That is, they work all over the patient, 
and work pretty near a half hour, so that the patient will think he has had a 
good treatment, so that if there is a placa that should be treated, he will be 
sure to hit it. That is the way the Osteopathic quack will work in most in- 
stances, taking into consideration that the effect is toward the normal, he gives 
a nice stimulating treatment all over the body, and if he strikes a few hsions 
they may be helped, as the tendency is toward the normal. That will explain 
how he happens to get results in some cases. Then, our work is to remove the 
lesion, and not to be afraid that we will disturb the normal conditions. 

Further, concerning work upon abnormal parts, it is considered as a priu- 
'^iple in our practice that we should work against the resistance we meet. That 
is a little hard to explain, and it is not a principle which will apply as generally 
as some others. That is, to move the part in the direction in which you will 
cause the unnatural tension to appear, jiecause if by moving the part in a cer- 
tain direction, as for instance, flexing the limb, you find that there is an un- 
natural tension opposing the normal movement, you then see you have a lesion 
with which you are dealing, and in working against the unnatural tension you 
are working against the lesion, at least in some cases. This, then, becomes a 
method of how to work to remove certain lesions. Dr. Harry says he always 
"springs the part," as he expresses it, in the direction to cause the most pain. 
Frequently you will find that the manipulation that yuu put upon a part will be 
diagnostic in part, and that it will often reveal to you certain lesions of the 
kind I have described. Remember, that in such cases your cue is the pain that 
you find. For instance, I might find a contraction in the pyriformis muscle in 
case of sciatica. The cause frequently of sciatica, from our standpoint, is a 
contraction of this pyriformis muscle in such a way as to impinge upon the 
sciatic nerve, which runs under it. So that you will then have an abnormal 
tendency to the external rotation of the head of the femur, and the movement 



90 

that we adopt is of* such a nature as to stretch the pyriformis muscle. The 
same thing is seen in the stretching of the ligamentum nuchae, or the stretch- 
ing of the sterno-mastoid muscl'^. I bave seen cases in which that muscle was 
stiffened and contracted, in wry neck, and the treatment was to stretch the mus- 
cle. This will illustrate what I mean when I say to work against the resistance 
which you will find, and that that is a cue to the lesion itself. Of course that 
may not be a primary lesion, it may be a secondary lesion as in the case of the 
sterno-mastoid, the primary lesion may be something affecting the spinal acces- 
sory which innervates that muscle, but at any rate it has set up a certain troub- 
le which must be corrected. That is not, as I said, a general principle; you 
cannot apply it everywhere; it applies especially to parts which may contract 
and thus form obstractions. Do not be too eager in carrying out this idea, be- 
cause you may ir.'itate the parts. In trying to get the cue you may do harm ; 
I have seen that done. 

In the removal of lesions the question of stimulation or of inhibition be- 
comes secondary, since the lesion being removed, nature tends toward the nor- 
mal. Nevertheless, there come times in our practice when we must either stim- 
ulate or inhibit according to the rules laid down. As for instance, after we 
have removed the lesion and we have still to treat the parts to strengthen them, 
the question arises once more, what shall we do in this case, stimulate or in- 
hibit; so that our, work is not entirely confined to the removal of lesions. 
Sometimes the lesion is not apparent, and we simply have to go to work at the 
innervation of the parts and get the results that we desire, either by stimulation 
or by inhibition. The disease may be of such a nature that this will be the 
rational method of treatment. Not that we should not look for lesions aiv>ays, 
but sometimes we have to get to work directly upon nerves. For instance, in 
diarrhea or flux, their abnormality must be of nerve foroe, it frequently hap- 
pens that we simply have to treat that case by strongly holding the spine, that 
is, inhibiting the sympathetic nerves, even though we may not attliat time cor- 
rect some lesion in the spine. I frequently simply inhibited strongly all along 
the lumbar region, and I certainly did nothing there but inhibit nerve action. 
In obstetrics the partuition center is stimulated at certain times to cause iju* 
contraction of the circular fibers of the uterus; we are not removing a lesion in 
that case, we are stimulating to bring about the desired end, and are woriviug 
upon the nerves which control those muscles. In some headaches we cauuot 
liud any particular lesion ; we very frequently go to the sub-occipitals and hold 
them and inhibit them there — the sub- and great occipitals ; in that case we 
have inhibited. In the casj of epistaxis we must simply stimulate in the nerk. 
or in the case of hiccoughs, which is a very good example, we often do notlmm- 
but go to the phrenic nerve and inhibit it by bring pressure upon if. So I think 
the [)oint is well taken, that we must sometmu^s stimulate or inhibit witlu>ut 
removing lesions, either after removal of lesions, or in the absoncv' of ^iisrover- 



91 

able lesions. That then brings up the point that there must be some different 
movement which we employ to stimulate or inhibit. The difference in stimu- 
lation and inhibition is well illustrated by a simple phenomenon — a very light 
touch over different parts of the body will cause a tickling sensation, which 
may become almost unbearable ; whereas a firm pressure at the same place 
simply removes the conductivity of the nerves or inhibits. The other was a 
stimulation. In general the movement used to inhibit is a holding or pressing 
motion ; I will show you that later; a holding or pressing motion, having as 
its end m view the idea of quieting the excitability of the nerve, that is, the 
lessening of its conductivity, which we know is done by pressure. We have 
seen that to be a fact according to the authorities. Thus, in that pressure upon 
the phrenic nerve we quieted the spasm of the hiccough. In general, alterna- 
tion of pressure and relaxation of pressure, is used to stimulate, the idea being 
to excite, to titillate, and this is comparable to the "making and breaking'^ of 
an electric current. We use alternate pressure and relaxation, and the idea is 
to in that way arouse nerve force. For instance, in a Case of nose bleeding we 
have to rub the superior cervical ganghon, and thus stimulate the tonicity of 
the blood vessels. In stimulating we work frequently along the spine, giving 
a stimulating treatment, described by one as working hard and fast, making 
and breaking. We simply keep working in that way. We do not adopt the 
pressing motion, what we use is a quick, stimulating motion. At least that is 
the Osteopathic view of how we stimulate or inhibit. That is the technique of 
manipulation. Perhaps I do not fully agree with all that the phj^siologists say 
on the subject of stimulation and inhibition, but I think I have shown that we 
have a pretty good allowance of authority, from quotations made, and that is 
the way we get results. This, then, would naturally bring us to consider the 
question of the degree of force that we should use. It is certain that you can 
stimulate so assiduously that you can get the opposite result, and finally in- 
hibit instead of stimulate. The secret of it is that stimulation must amount to 
irritation, which if performed too frequently or if done too hard will, after it 
has run its course, result in the nerve refusing to respond to the usual •tioiu- 
lus, and finally to respond to any stimulus if the irritation is carried far enough. 
So that stimulation may become irritation, and finally inhibition. 

You must remember in treating a patient to adapt the degree of force to 
the end in view. This refers not only to the treating of a case, how hard to 
treat at the time, but the treating of a case too often. I wish you could all 
have heard what Dr. Conner said yesterday concerning the practice outside. 
He said a great many cases have to be treated too often. A patient comes into 
your office, and you tell him, "I want to see you not more than once a week, in 
your case I can do you as much good in treating you once a week as I could 
treating you three times a week or every day." And that is a fact, but the 
patient wants to get all he can for his money, and he says, "You are charging 



92 

me $25 a month and I think I ought to get more than foar or five treatments, 
that makes it come pretty high, and I would like at least two treatments a 
week." And it is almost impossible to prevent treating too frequently, but 
when you do, of course you are in danger of irritatiag. As I say, you must 
explain to the patient that by treating so often you irritate these nerves and 
structures and thus keep up an abnormal irritation instead of removing it. 
You might also say that it i? not you who cures, but Nature cures : you simply 
aim to assist Nature. Now, if you should treat so often, tell him you do not 
give Nature time enough betv^een times to work, and that you do not think it 
best. You have to learn these arguments that apply to such cases, as you v^^ill 
meet them frequently. When you say to Nature that you w411 aid her so much 
that she does not have to work at all, she finally gets tired of the effort and 
simply lays off and lets you do what you can. We had a case in Chicago of 
neuralgia of the fifth nerve which was treated once and disappeared for quite 
a long time. It finally returned and was quite a severe case, as hard a case to 
treat as any that I had ever seen. We tried all sorts of treatment and finally 
got to treating it pretty nearly every day, and it did not do much better. Final- 
ly we told the gentleman not to come back to us inside of a week or two weeks, 
we had by this time quit taking his money, but were trying to do what we 
could for him, so he was willing to do that. The result was improvement We 
had simply stimulated until we had irritared and had kept up the abnormality. 

Then, again, some lesions must be, removed only gradually. If you go 
to work and remove the lesion instantly, you do not give nature time to ac- 
commodate herself to the changed conditions. Nature has been for years at 
work trying to adapt herself to the unnatural condition of things, and she has 
done so to a greater or less extent finally, and now you, as an Osteopath, try 
to change all that in a second's time. It can rarely be done. I have known 
some cases where a very quick change of a lesion could be made, but it is 
not a very common occurrence. I have heard Dr. Harry Still state that he 
had set a hip too soon and he had great difficulty with it until he had got it 
out again, because the muscles were all so contracted by being adapted to the 
abnormal conditions. They would not relax as they would normally have 
done when the hip was in place, and he had great trouble to get it out again. 
The lesion should not be reduced too soon. In a case of asthma the -'Old 
Doctor" says you should not treat oftenerthan once in ten days ov two weeks, 
because by frequent treatment we keep up the irritation. 

I wish as soon as possible hereafter to take up certain centers and tlic 
consideration of the sympathetic system, that I left aside after the first few 
lectures, as it is an iniportant subject. There are certain things which 1 wish 
to bring to your attention to-day in regard to them. Hemeniber that stimu- 
lating accelerator fibers accelerates and stimulating inhibitory tibers inhibits. 
For instance, if you were to treit the lieart and wish to stimulate its action. 



93 

you will recollect that there are two sets of nerves innervating the heart; one 
the sympathetics, and the other from the pneumogastric. That the sympa- 
thetic keeps the heart running and tends to run it too fast, while the inhibi- 
tory influence of the pneumogastric is to bring about an equilibrium between 
the forces and keep it running just right. If it is not running just right, not 
fast enough, you will want to stimulate it a little, in which case you would 
stimulate the sympathetic supply to the heart through the upper dorsal and 
the cervical ganglia and you would inhibit the pneumogastric so as to remove 
the inhibitory influence. You would thus, according to the theory, get a 
stimulating effect upon the heart. If you wish to quiet the heart's action 
you would adopt just the opposite plan of treatment. That will illustrate the 
fact that stimulating a nerve stimulates it to its action, whether its action be 
that of an accelerator or an inhibitor. Stimulating vaso-dilators dilates. 
Stimulating vaso- constrictors constricts. This is very simple and perhaps 
it seems unnecessary to call it to your attention except in the connection it 
has with these other things. There are certain things to remember in rela- 
tion to the vaso-motor system, and which though hard to explain are of a 
great deal importance to the Osteopath. There are certain things concerning 
the centers and the fibers. It is said that vaso-motor fibers are present in 
some cranial nerves, for instance, the chorda tympani of the fifth nerve. The 
chorda tympam is the vaso dilator of the submaxillary gland. The general 
vaso motor center is in the medulla. It is said by Howell's Text Book how 
ever, that that center is a constricting center, from which a continual con- 
strictor impulse goes to all parts of the body, preserving the proper tonicity 
of the blood vessels, but he says it is not proven that there is any vaso-dila- 
tor center in the medulla. Simply not proven; there may be, however. The 
vaso -constrictor fibers, as before stated, leave the spinal cord from the second 
dorsal to the second lumbar, while vaso-dilators leave the cord all the way 
along, being not limited to certain places. 

We frequently meet with the terms, in description of the circulation, in- 
crease of blood pressure, and so on. Eemember that stimulating vaso con- 
strictors constrict the blood vessels, and thus lessens the quantity of blood 
in that part, but it increases the blood pressure. On the other hand, the 
vaso-dilators loosen the tissues and allow more blood to go to the part, but 
decrease the amount of blood pressure. I thought I would call that to your 
attention so you would not get those facts confused. 

A further fact that you must take into consideration is that sometimes a 
single anatomical nerve will contain more than one kind of fibers, vaso- dila- 
tor and vaso-constrictor fibers. That is true in the case of the sciatic 
nerve, and the result you would get in stimulating the sciatic nerve 
would be an average result between vaso-dilator power and vaso-con- 
strictor power. Again, sometimes stimulating a center will produce vaso- 



94 

dilation and sometimes vaso-constriction. You might have a vaso-dilator 
center and expect it always to produce vaso- dilation, but according to Howell's 
Text Book the center is sometimes changed in condition, and you get the op- 
posite effect by its stimulation. Yaso- constrictors are less easily excited than 
vaso -dilators. Yaso-constrictors degenerate more rapidly when injured. 
The maximum effect of stimulation is more readily reached in vaso-constric- 
tors than in vaso- dilators. Yaso-motor nerves are axis cylinders of sympa- 
thetic nerve cells. The pilo- motor and secretory iibers we shall consider later 
when speaking of the structures in which they terminate. As we cannot be 
certain of all these things we have to depend more than ever upon the tend- 
ency toward the normal — we cannot always work to get a set vasomotor or 
vaso-dilator effect. 

II. Treatment OF THE ^N'eck. (Continued.) — The spinal accessory, 
pneumogastric and glosso-pharyngeal nerves emerge at the jugular foramen. 
We frequently have to treat them, especially the pneumogastric and the 
spinal accessory; the pneumogastric perhaps more often. We treat them in 
various ways. We can reach the pneumogastric by deep pressure over the 
exit from the skull — deep pressure just below the mastoid process will affect 
the nerve. Some work there. Others on the pneumogastric by stimulating 
all along the anterior border of the sterno mastoid muscle. Thus you get a 
sort of a massage and direct mechanical pressure upon that nerve and no 
doubt affect it there if our theories are correct. Another very good way to 
reach these three nerves is through the superior cervical ganglion. That is, 
we work on the superior cervical ganglion to affect them. We may affect 
the superior ganglion by working on the sub and great occipital nerves. That 
is rather an indirect way, but it is claimed that we get an effect upon those 
nerves by working that in place. That is the method Dr. Hildreth used to 
reach those the nerves. 

There are various ways in which we reach the phrenic nerve, one way is 
to carefully find its location opposite the transverse processes of the third, 
fourth and fifth cervical vertebrae, and get slightly in front of them and im- 
pinge back upon them, thus pressing the nerve against the transverse pro- 
cesses. That is one way. The way that Dr. Harry Still treats the plirenic 
nerve is by thrusting the thumb between the clavicle and the first rib above: 
that is, thrusting it above the clavicle, between it and the first rib, then push- 
ing the bent arm and hand on back over the shoulder in this way, thrusting 
the thumb deeply in there at the sternal end of the clavicil and lioldiug in or- 
der to impinge upon the nerve and lessen its conductivity, thus inhibiting th(^ 
action of that nerve. It is sometimes reached, as I showed you tlu' diIum 
day by pressure at the sternal end of the clavicle. You can eitlicr prt'ss in 
the fonticulus gutturis, slightly backward, or between the sternal and chn ir- 
ular ends of the origin of the sterno mastoid muscle, backward and inwarii. 



95 

to impinge upon the nerve. The best place to treat it is the best place that 
your practice tells you you can reach it. Different ones treat in different 
places, and it also depends upon the patient, as to how thick or how thin his 
neck is. 

Next we will consider the treatment of the sterno mastoid muscle. We 
can get a direct sort of a massage by working right along its course. It is 
very readily worked upon in this way, relaxing it and drawing it toward you 
without rubbing the fingers over the neck. Another way is to follow the ob- 
liquity of the muscle and turn the head, thus stretching the muscle on the 
same side. Eemember that, on account of the obliquity of the muscles be- 
hind, you will at the same time stretch them, and I find that a very good 
plan in giving the neck a general treatment, as I will show you later. Of 
course you may have some trouble with the spinal accessory nerves causing a 
stiffening of the sterno -mastoid, in which case you must give it attention. 

Now as to treating the neck proper, or the back of the neck. The first 
thing is to loosen up all of the muscles. In giving this treatment I always 
use the flat of my hands, and lay them directly on the neck, and have thus a 
broad hold and do not run any risk of hurting by pressure with the tips of 
fingers. I usually go to work in this way and work straight backwards, thus 
loosing all of the muscles, giving a certain twist or turn as I work. You will 
be able to recognize by the sense "of touch when you have relaxed everything. 
It is also good to relax the muscles by working from the side. Remember, 
above the third cervical to work upward and below it downward. I simply 
relax all the muscles that are rigid. Then when you have them thoroughly 
relaxed, it is a good idea to still further relax the deeper structures by a 
straight pull. I hold beneath the jaw and occipital protuberance and draw 
the patient toward me, that stretches the neck. I have warned you not to 
turn it while stretching it in that way. I then turn the neck strongly from 
side to side in this general treatment of the neck, loosening all the deeper 
structures, stimulating all the parts about the vertebrse and loosening the 
ligaments. Then before finishing the neck I usually stretch the ligamentum 
nucha and also the other ligaments about the vertebrae, as I have already 
shown you how to do. 

It is an important question how to treat the cervical ganglia of the sympa- 
thetic. As I said, we usually affect them by treating the sub- and great occip- 
ital nerves, that is, by pressure in the sub-occipital fossil. The way Iq which 
we inhibit their action is by holding deeply in those fossae and then turning 
the head from side to side, rotating it as you go, and you thus work deep into 
the parts trying to get direct pressure upon the sub- and great occipital nerves. 
Through their connection with the cervical sympathetic you influence it. Some 
operators treat that way ahuost entirely and results would indicate that they 
were accomplishing what they were attempting. You must not be in a hurry, 



96 

but turn the head from side to side and hold firmly. Some treat the first gan- 
glion diret tly by pressure opposite the second and third cervical vertebra?, a 
little in front and backward, thus impinging it against the hard parts of the 
spines beneath. In the same way you can reach the second one, the third I 
think you cannot reach from the front of the neck, that must be reached indi- 
rectly through sympathetic connections with the spinal nerves behind. 

To stimulate these ganglia, pressure and relaxation are employed. 

In treating an atlas we use a combination of motions already shown, that 
is, a thorough loosening up of all the parts. Then by traction, rotation and 
pressure upon the prominent part you can work it back into its place. Of 
course it takes time, and frequently has to be done very slowly. That same 
method can be pursued for all the cervical vertebra. It is something you will 
have to learn by experience. Another way to set the atlas is with the patient 
sitting on the chair. This is a movement that Dr. Still showed us not a great 
while ago. He gets his knee under the jaw and rotates the head in a direction 
to throw out very prominently the part w^hich is out of place, and then getting 
his thumb or fingers upon that part and simply rotates the head back again, 
the idea being extension and flexion in such a way as to disengage the articu- 
lar processes and allow the part to resume its normal position. 

In order to work out the sore places that you will frequently find in the 
sub-occipital fossae and just beneath the occipital protuberance you should re- 
lax all the parts, both the ligaments and the muscles. 

I will now show you how I usually work upon the neck : I will work just 
as if I had come in and found this neck in a generally bad condition and wish 
to relieve it. The treatment of the neck is a very important thing. You need 
noi be afraid of getting down close to the shoulder and stretching all of those 
muscles. It is a good thing to get the head against you and push downward 
as you turn, you can thus sometimes relax the parts and start the vertebrtv 
toward their normal position. It takes considerable time to treat a neck 
thoroughly and well. One thing which I did not mention is that you can 
stretch the scaleni muscles very readily by holding the head straight and turn- 
ing it, pushing it directly to the side. If it is a case of headache I save the 
inhibiting movement until the last, and by holding firmly in the superior cervi- 
cal region, particularly at the sub-occipital fossjv, I get good results as a rule 
on the head in that way. 

Q. You were speaking of stretching the pyriformis muscle. Please 
siiow us how^ that was done? 

A. That muscle is on external rotator, and an extreme internal rotation 
will be all that is necessary to stretch it. Work opposite to the defect. 



97 

LECTUEE XYI. 

At the last lecture I invited your attention first to the general principle of 
our treatment, that manipulation always tends to restore parts to normal, fol- 
lowing it out along the idea that therefore should we manipulate a part which 
was not diseased, we need not be in any fear that we would make it abnormal, 
because the tendency would be to excite it in the way that normal exercise 
would excite it. But we by manipulation of the abnormal, on account of this 
tendency, result in tending to the normal and in helping to cure the disease. 
That is a partial explanation of why our friends, the '-engine wipers," who 
work over nearly all the body and work for nearly an hour, can get some re- 
sults, when they are not Osteopaths at all. Another point was that you 
should take the pain as the cue, and to work the part or stretch it in the direc- 
tion in which you get the resistance, since thereby 3011 work against the lesion. 
I explained about how general that should be, that you should not irritate in so 
doing. Although the question of stimulation and inhibition is a secondary one 
to removal or lesion, that we sometimes stimulate or inhibit irrespective of 
lesion or after removal of it. In general, we inhibit by pressure, by holding: 
and stimulate by brisk work like making and breaking of an electric current, 
and that there was a question of degree of force ; that you might stimulate 
hard enough to inhibit. There were certain elementary points concerning 
nerves which I thought would be profitable to bring to your attention : That 
stimulating an accelerator nerve accelerates, stimulating a vaso-dilatoi* dilates, 
stimulating a vaso-constrictor constricts. I also called certain centers to your 
mind, the fact thatr the center in the medulla is a vaso-constrictor center, and 
that a vaso-dilator center has not been found to exist, although it may be there. 

I. The Phrenic Nerve. What I wish to-day to do is to notice more par- 
ticularly something concerning the phrenic nerve. You all know its location 
and treatment ; how it arises from the 3d, 4th and 5th cervical nerves, espec- 
ially the fourth, having some branches from the third and a recurrent branch 
from the 5th ; that it is reached in different ways : being impinged against the 
transverse processes of the vertebrae, or being reached at the fonticulus gat- 
turus, or between the first rib and the clavicle ; that it is important to us, bat 
has been so mainly as a means of stopping hiccoughs. However, I think it 
should >^e of greater importance to the Osteopath, and while I have not heard 
these matters brought out that I am going to bring out this afternoon, yet I 
mention them in the way of suggestion for further work. Perhaps I do not 
iinow all that others have done with the phrenic nerve j these points are more 
in the manner of theories, but if what I have already said is true, certainly the 
phrenic nerve has considerable importance to us as an adjuvant to our work. 
The phrenic nerve has important connections with the sympathetic system. 
Gray says that the phrenic nerve supplies the pericardium and the pleura by 
filaments ; that in the thoracic cavity a filament is seen from the sympathetic 



98 

joining the phrenic nerve, and that there are also branches to the peritoneum. 
From the right nerve there are branches to the phrenic ganglion, which is situ- 
ated just below the diaphragm, the terminals of course, perforating the dia- 
phragm to reach this phrenic or diaphragmatic ganglion of the sympathetic- 
This ganglion of the sympathetic is, of course, connected with tne solar plexus. 
This ganglion sends branches to the hepatic plexus, and also sends some fila- 
ments to the inferior vena-cava. Of course its function as a spinal nerve is to 
supply the muscle of the diaphragm. From the left nerve branches go to join 
the solar plexus, but there is no ganglia formed. Quain substantiates those 
points, and says further that branches reach the phrenic in the neck from the 
middle or the lower sympathetic ganglia, some branches going to the pericard- 
ium. And that from the right nerve were branches going to the inferior vena 
cava, both above and below the diaphragm, and that branches also go to the right 
auricle of the heart. Pansini, according to Quain, has found in animals that 
the phrenic plexus of the diaphragm is participated in by the lower three inter- 
costal nerves. You will see that the purpose is to associate the muscles of res- 
piration, the abdominals, intercostals and the diaphragm itself. Quain states 
further, that the phrenic may have a branch from the hypoglossal nerve and 
from the 5th cervical nerve. Such are the facts in relation to the phrenij and 
its distribution. When we examine those facts in the light of Osteopathy, it 
seems certain that we find the phrenic significant to us in more vvays than one. 
You see from what I have said that the phrenic is connected with the sympa- 
thetics ; first with the middle or lower sympathetics in the neck ; next, that it 
receives a filament from the sympathetic in the chest; next, that it perforates 
the diaphragm to join the nerves of visceral life, those on the right running 
from the diaphragmatic ganglion, those on the left joining without the inter- 
vention of a ganglion. You notice further that it has a connec^tion with a cran- 
ial nerve — the hypoglossal ; that it has branches connected with the brachial 
plexus, that is, from the 5th cervical ; and that it may perhaps join with the 
lower three intercostals, but I do not know that that has ever been shown to 
be true in man. The conclusion is obvious, then, from what we know of the 
connection of nerves in different parts of the body, both sympathetic and other- 
wise, that if any of these sympathetic, spinal or cerebral nerves were diseased, 
the disease might conceivably be extended to the phrenic and affect it, and that 
we might have phrenic symptoms arising from these other troubles. The re- 
verse of course is true, and that any of these structures which are supplied by 
the sympathetics or these other nerves, may reflexly affect the phrenic nerve. 
You have seen that it supplies the pericardium, pleura and peritoneum, that it 
supplies one of the great blood vessels, the inferior vena cava, and sends 
branches to the right auricle of the heart, and there is no reason, according to 
Hir theory, why disease in any oi these situations might not affect the phrenu- 
nerve, and you might have symptoms of disease in the phrenic nerve. 8o that 



99 

our theoretical rule is certainly a good one, for it will work both ways, either 
affecting the phrenic nerve or the other structures as the case may be. The 
importance of this to us lies in the fact that it would be an adjuvant m the 
treatment already used. It is one more path bA^ which we can influence nerve 
force. We have certain ways of reaching the abdominal viscera through the 
splachnics in the back ; we might have a case where we could not get at it in 
that region, but if we could reach the trouble through the phreuic, we would 
accomplish the desired result. As I have said, these facts are not fully demon- 
strated, but it is a theory which I leave for your consideration, and which you 
can work on in your practice. It comes to us as another key to unlock the 
doors of sympathetic life ; another way in which we can work ; another tool 
in our hands. 

I wish to call up what Dr. Hilton says in regard to the phrenic nerve; 
he sets out very clearly why it is that it perforates the diaphragm and is dis- 
tributed on its lower surface rather than upon its upper surface. He shows 
that were it distributed to the upper surface the nerves would then be im- 
pinged upon by the lungs, and you would have constant interference with 
nerve force, but it is distributed on the under side of the diaphragm where it 
is removed from the tendency of pressure of parts above, and the tendency of 
the force of gravitation is to draw away the stomach, liver and spleen from 
the under surface of the diaphragm, so that there can be no interference with 
the plexus situated below the diaphragm. Dana makes use of this tendency' 
of gravitation in the case of hiccoughs, but in a somewhat different way. That 
is, he states that it has a very effective action in hiccoughs. He places the 
patient on a table with his head down over the edge of the table; that would 
allow the thorax to arch up, and the action of gravitation would allow the 
heavy viscera to impinge upon the under surface of the diaphragm, and it 
would in that way be helpful in stopping the hiccoughs, by inhibiting the 
nerves of the plexus. Hilton does not explain it so. It may be that the 
stretching of the thorax, thus extending the contracted muscle would hj its 
extension send an impulse back over the nerve and quiet the spasm. I have 
not heard it explained why the drinking of cold water stops hiccoughs, but 
there may be an explanation here in connection with the symj)athetics; that 
the action of the cold water may be such as to for a w^hile inhibit the action 
of the sympathetics, sending an action reflexly back to the phrenic from its 
sympathetic connections, and thus causing the spasm of the hiccoughs 
to be released. So that in our work upon the abdominal viscera we may 
avail ourselves of the advantage of w^rk in the neck on the phrenic. Dana 
states that he treats diaphragmatic palsy by electricity^ applied to the neck. 
He says there is a motor area in the neck which is readily affected by the 
electric current. So that it no doubt corresponds wdth the work we do when 
we bring pressure directly upon the phrenic nerve. 



100 

I wish to qnote from Dr. Jacobson along this line as follows: ''Another 
reason for the phrenic nerves traversing the diaphrao^m, and breaking- up into 
branches on its under surface may be taken to enable them to come into com- 
munication with the sympathetic or visceral nerves of the abdomen. From 
this communication branches are given to the hepatic and solar plexuses, and 
the inferior vena cava. Everyone knows the value of active exercise when 
certain abdominal viscera are torpid iu the performance of their functions, e. 
g., in constipation, biliousness, etc. The perforation of the diaphragm by 
the phrenic and its communication with the abdominal sympathetics must bring 
the brain and spinal cord, the diaphragm and abdominal muscles, so important 
in active respiration, into intimate association with the subjacent viscera." So 
says Dr. Jacobson. Hence, we see that we can go farther, and say, that since 
the brain and cord are thus brought into connection through the phrenic with 
the sympathetics and with abdominal sympathetic life, and since it must send 
certain impulses along those nerves and thus affect abdominal sympathetic nerve 
life, there is no reason why the reverse may not be true. And why may we no 
affect the brain and cord by working back from the sympathetics, and more 
particularly when there is a lesion, because manipulation must tend toward 
the normal? You would manipulate the phrenics ; the abnormalities would be 
affected, you would affect the phrenic, and thus be more likely to affect other 
nerves which have under control that which has become abnormal. There is 
no reason, according to our theory, why we would not tone up the whole mech- 
anism of respiration, especially the muscular respiration, since it is in connec- 
tion with the phrenic nerve and with the abdominal. 

I emphasize once more what I have said frequently before — that work 
upon nerve terminals will affect the nerve itself and will affect the center from 
which it comes. I think that position taken by Osteopaths is impregnable. 
I wish to quote from Dr. Hilton in a case of pain in the knee, where the 
trouble was in the hip, which the Osteopath often meets, and which shows us 
that doctors are not always in the dark in their diagnosis of these cases. Dr. 
Hilton says: ''Again, we find some patients with hip-joint disease suffering 
from pain in the knee. Now, although the disease does not lie there, we 
know that the pain can be relieved by a belladonna plaster, or strong hem- 
lock poultices, or fomentations applied over the knee joint; thus acting upon 
the nerves of the hip joint through the medium of those which are spread 
over the knee-joint." He has made the point previously that the nerves of a 
joint supply also the skin over the joint and over the insertion of the muscles 
which move the joint. So you have one nerve going to a joint, to its muscles 
and to the skin over those muscles. We see that the therepeutie value of 
work upon nerve terminals lias been recognized and used long before this. 
Our method is peculiar in this: that it works upon nerve terminals exclusive- 
ly by n)ani])ulation and its effects. Pevha])S some of you have heaivl of cer- 



101 

tain exercises for troubles of the stomach, bowels, liver, etc. It is recom- 
mended that the patient who has torpid liver should every morning get down 
on all fours, that is, keeping the legs stiff and walking on the hands and feet, 
and run briskly around the room. That if he would do that it would press 
the liver and squeeze it like a sponge and could not help but stir up the 
torpid circulation from the portal system. There is another stooping motion 
given in which the patient keeps the back straight, bends his knees and 
allows his body to sink down straight, then he can bend so that the shoulders 
push against the knees. You will notice that it is a sort of pumping 
motion, it will stretch the spine and kneed the bowels and abdomen thor- 
oughly. Often this may be of practical use, and you might suggest it to 
patients with similar troubles. Now, what would be the effect in such a 
case? I do not think it would be simply local in pumping the blood through 
the abdomen and its contents. I think that the tendency there would be to 
affect the nerve supply, if our work and our theory go for anything, and af- 
fect generally the abdominal nerves, and through them the centers, which 
may themselves be in an abnormal condition. The tendency continually tow- 
ard the normal would tell us why work upon the abdomen should affect cere- 
bral centers and thus restore them to the normal. We had quite a marked 
case in Chicago some time since. A lady patient told Dr. Sullivan that she 
had been treated by an Arabian doctor, who adopted a queer method. She 
said he had directed her to fix her mind upon the point in view every day at 
a definite time, and he had given her particular instructions as to how it 
should be done, and she said she was perfectly restored from constipation. 
The explanation given was that by thus working on the mind this doctor had 
finally led his patient to gain control of the cerebral center which has to do 
with these functions. 

I have already examined the neck before you, and shown you bow to treat 
it. I think we are ready to take up the head. I may say io passing that it is 
my idea to first go over the body piece by piece, give j'ou the exammation and 
treatment for different pieces of the body. That is a piecemeal way to do, but 
I think it will give you an analysis of the whole. After I have dona that we 
shall have a synthesis, and I will take up special diseases and show you how 
to examine and treat the case, combining different movements and treatments 
according to circumstances. 

II. Landmarks of the Head. Holden notes the following: That the 
scalp is '^ery tough and dense on account of its close connection with the 
aponeurosis. That its density, therefore, often obscures the growth of tumoi'S 
upon the cranium. A tumor beneath the aponeurosis may very readily be 
confused with a growth from the scalp itself or from the brain, and in general 
such tumors are firm and resisting. Other tumors that are above are very 
readily movable, and when they are movable I believe the point is general 



102 

that they are not so serious. The supra- orbital artery is felt pulsing just 
above the notch. You all know where the supra orbital notch is, at the 
junction of the inner and middle third of the supraorbital arch. It runs 
thence up over the forehead, and by carefully feeling you will be able to note 
the pulse. 

The temporal artery is felt an inch and a quarter behind the external an- 
gular process of the frontal bone. The occipital artery is felt near the middle 
of a line drawn from the occipital protuberance to the mastoid process. The 
posterior auricular artery is felt pulsing near the apex of the mastoid process. 
I think it is a very good way to train the touch to feel for the different art- 
eries at different places. 

It is said that the skull cap is rarely exactly symmetrical. The promi- 
nence of the frontal, parietal and occipital portions of the cranium is a partial 
indication of the development of those respective parts of the brain, and it is 
stated a good way to measure the relative proportions is to pass a string from 
one external auditory meatus to the other, first over the frontal, then over 
the parietal, and then over the occipital eminences," and thus you can get an 
idea of the comparative bulk of these lobes of the brain, because it is said the 
lobes of the brain correspond in general to these parts. 

The anterior fontanelle in the infant you are all familiar with. It should 
be carefully noted whether the condition is a hill or a hollow. Of course 
normally it is even. If it is a hill it will indicate too much cerebral fluid 
present, as in hydro- cephalus. But if there is a wasting of the fluids of the 
body, as in diarrhea, you may have a hollow there. Normallj^ the rate of 
pulse beat may be counted at the fontanelle of a sleeping infant. The frontal 
sinuses do not gain their normal size until after puberty. The absence of 
them is not indicative of much because they grow inside, or if they are very 
prominent it may be simply a heaping up of the bone, and a degeneration. 

The mastoid process is filled with air cells, lined with mucous membrane, 
and it may develop as other mucous membranes do, a catarrhal condition and 
lead to suppuration. The occipital protuberance is the thickest part of the 
skull, about three-quarters of an inch thick. The part at the temple is the 
thinest, and may be as thin as parchment, it is stated. The external auditory 
canal runs slightly foward and inward, hence in examining you must pull the 
auricle backward and upward. 

Marks for the face. The three points of the three terminations of tlu^ 
fifth nerve are at the supra-orbital, infraorbital and mental foiamina. respect- 
ively. A line passed down from the suj)ra- orbital foramen, passing between 
the two bicuspids, will pass over these three foramina. Of course nerve tei - 
minals are important with us, and we get an important t^ffect on tlit- tiftli 
nerve by working on these terminals. The two Iowcm* foramina look towind 
the nose. : . 



103 

III. Examination of the Head and Face. Of course I do not need to 
state to you that the examination of the head and its parts, embodying as it 
does, the eye, ear, nose and throat, upon any one or two of which some men 
spend a lifetime of study and work, lecture and treatment can be encompassed 
by a few lectures. We all recognize the importance of the subject. Howev- 
er, I thiiLk: we can take a general view of this subject now in a few lectures 
and depend upon later lectures and later experiences to enlarge upon our 
knowledge. The Osteopath has good success with troubles of the head, brain 
troubles, diseases of the eye, ear, nose and throat, and diseases of the face. 
His treatment is very simple, being for the greater part in the neck. Troubles 
of the eye and the ear are, as you know, closely associated with the superior 
cervical ganglion of the sympathetic and with the various vertebrae. Dislo- 
cations of these vertebrae are very important. The atlas will affect the ear, 
and the atlas and upper cervical will affect the eye. So that in any examina- 
tion that you make of the head and its parts you must do it in connection 
with the neck. Please remember that the separation of these subjects has 
been merely for convenience, but that they must all work together. For in- 
stance, you may find a catarrhal condition of the head where the cause may 
be entirely in the neck. You may have a case of insanitj^ where the trouble 
is wholly in the neck. With these remarks I think you will note the im- 
portance of examining the neck and treating it in conjunction with head 
troubles. 

In examining a patient at any time you should note the size and shape 
of the head; you should look for the presence of tumors or ulcerations upon 
the scalp or beneath it, and also carefully examine to see if the head is bald. 
Always notice the face, as it is a great indicator of disease; notice the counte- 
nance; the expression. You will frequently come across in medical literatui^e 
the fact that the patient has a worried expression. Your patient will some- 
times wear an anxious expression. Different diseases affect the countenance 
differently, and you will often meet this anxious expression of countenance? 
so that is an important indication, as is also the complexion. You have aU 
seen the complexion of jaundice; stomach trouble will have its effect upon the 
complexion; certain diseases of the genitals will cause eruptions on the face. 
These things you wiU bear in mind. In looking at the face always note the 
lower jaw. It is especially important from the Osteopathic point of view. 
It may be slipped backward or forward or it may be deviated from one side, 
and in being so may cause a tightening of the ligaments of the jaw causiug 
serious results. It may affect the ear, or it may have something to do with 
neuralgia of the fifth nerve. 

In looking at the eye. always notice the conjunctiva, whether or not it is 
engorged with blood, whether or not it is yellow, whether there is any growth 
upon it, or any abnormality whatever concerning it. Note whether or not the 



104 

eye is brilliant; in some it is dull. All of these points should be significant to 
you. There may be growths upon the eye, pterygium, which have been suc- 
cessfuU^y treated by Osteopaths. You may find cataract; we have had some 
success in curing this also by Osteopathy. It is well in examining a patient to 
note whether or not the iris reflex can be obtained. Dr. Harry Still always 
says there is considerable hope for an eye if you c^n find upon examination 
that the ins will readily dilate. He just taps the closed eye, putting one finger 
upon it. tapping three or four times gently with another; if that has caused the 
iris to dilate you will know that the reflex is intact. You can also determine 
this b}' shutting off the light and then instantly turning it on, the reflex being 
manifest in the same way. You should in your examination of the eye note 
what is the color of the mucous membrane. A very pale color will indicate an 
absence of suflficient nutriment; absence of blood supply. In anemia the mu- 
cous membranes of the whole body are pale, hence you will want to examine 
the eye in health to acquaint yourselves with these phenomena. In examining 
the eye we have to turn back the lids, the under lid is very readily turned back 
and down, and you can examine it and notice if there is any foreign body upon 
it. The upper lid is not quite so readily turned back. You can do it with a 
pencil, or you can push it right up and back. Note the meibomian glands and 
note whether or not there are any granulations or any foreign growths. It will 
be well for you to note whether or not the tonicity of the muscles about the eye 
is normal, holding the puncta lachrymala against the globe of the eye. A 
loosening of a muscle may cause the flowing of tears over the face, or some 
growth may obstruct the duct producing the same result, and you want to 
know whether or not it is simply a loosening of the muscles or some obstruc- 
tion in the duct. You may in looking at the eye discover a foreign body. 
Sometimes you cannot see it, sometimes you have to look obliquel}' across the 
cornea of the eye. It may be stuck on the cornea and you will have to look at 
it by an oblique light, so as see whether the surfaces are clear. Looking at it 
obliquely will also enable you to see pterygiums, although these are generally 
readily seen by looking at it directly. The presence of dead lashes is a suf- 
ficient cause of disease ; you can have quite a sore eye merely on account of 
dead lashes bemg left in the lids. They should, I think, be regularly pulled 
out every once in a while, and should be gently tried to see whether or not they 
will come out. It is said that if a person will keep them removed he is not apt 
to have trouble with his eyes. When they have become lifeless you will see 
little black points on the eye-lids. It is said a fullness under the eye is iutlica- 
tive of dropsy. The presence or absence of a ring about the eye is also indica- 
tive of the general health. 



105 

LECTURE XYII. 

I spoke last time of tbe phrenic nerve, showing how it has connection 
with the sympathetic, and advancing the theory that very possibly importatant 
results might be obtained Osteopathically by working upon this nerve tor the 
sake of influencing its connections, calling to your attention the fact that it 
supplied the peritoneum and pericadium, send braches to the inferior vena 
and a branch to the right auricle ot the heart. That it also connected with the 
sj^mpathetics below the diaphragm and thus had very important connections 
with visceral life. That it also connected with a cranial nerve, the hypoglos- 
sal, and with spinal nerves, viz., the 5th cervical, and that in some animals 
connection had been noted between the phrenic and three lower intercostal 
nerves. This connection with the muscles of respiration is to cause them to 
work in conjunction. That is the theory supported by the quotation from Dr. 
Jacobson — that work upon, or exercises that would influence the abdominal 
viscera would thus have an influence upon the brain. It seems likely that by 
work upon these parts we can get an influence over tbe parts affected and thus 
perhaps reach brain centers and gain an influence over them. I noted also the 
value of such exercises as stooping, those which would bring a squeezing 
motion upon the liver, intestines and stomach, and showed how it might 
through these nervous connections affect the parts which were at fault, I 
then explained certain points concerning landmarks about the head and face, 
and spoke on the subject of how to examine the head, face and its parts. I 
wish to-day to continue that line of thought, giving particular attention to the 
eye. 

I. Osteopathic Points CoNCERNmG THE Eye : — We are aware that the 
nerve supply of the eye, which is itself a nervous organ, is various and impor- 
tant, and we shall see later in the lecture that we have quite a broad field upon 
which to work to reach the eye. I have already given yoti some centers for 
the eye, and have already spoken, in considering the neck, about the blood 
supply to the head and its parts, and it is also of course veiy important to tis. 
We get our effect upon it through the nerves ; the superior cervical ganglion 
is the chief center upon which we work to affect the eye. I have seen a case 
of "blood shot" eye, as we commonh^ call it, cured by treating in the superior 
cervical region : simply by inhibiting the action of the sympathetics at that 
place. So you see the superior cervical ganglion has an important control 
over the mechanism of the blood supply. We probably affect it through the 
ascending branch to the carotid and cavernous plexuses, and no doubt also 
through the connection which it has with the fifth nerve — the fifth nerve hav- 
ing important vaso-motor fibres to the eye. Quain, in his anatomy describes 
branches from the cavernous plexus which run to the cerebral and ophthalmic 
arteries, forming a secondary plexus about them, and from them, he says, 
some branches go to the eye-ball and form a plexus of the sympathetic in the 



106 

eye-ball itself. Hence, you see, we have a very important and direct connec- 
tion with the sympathetic through the superior cervical ganglion, through its 
ascending branches, and this terminal sympathetic plexus in the eye-ball 
The ciliary ganglion is also important in relation to our work upon the eye. 
It has connection with the third and fifth cranial nerves and with the sympa- 
thetics. The third and fifth nerves are important, as you will see later when 
I shall take that up more in detail. Concerning the ciliary ganglion, Quain 
says: "The ciliary, opthalmic or lenticular ganglion serves as a center for 
the supply of nerves, motor, sensory and sympathetic, to the eye-ball." Thus 
we have a center upon which we may work. Further, he says, "The sympa- 
thetic root is a very small nerve which emanates from the cavernous plexus." 
80 the ciliary ganglion gets its sympathetic supply for the eye from the cavern • 
ous plexus. The ciliary ganglion lies at the bottom of the orbit between the 
rectus muscle and the optic nerve. There is a treatment which we frequently 
fi^ive the eye, not a tapping, but a pressure of the eye back into its socket ; and 
I think the effect there must be upon the cilliary ganglion, and since it is con- 
nected with the third and fifth nerves, we could undoubtedly, if there were ab- 
normalities, get an effect upon those nerves. Thus, working in this way we might 
affect the third nerve and tone up the muscular mechanism of the eye, or 
working in this way indirectly upon the fifth nerve, we might tone up the 
nutrition of the eye. Thus you see by pressure we have reached not a nerve, 
but a center, and the reverse is clearly true according to our theory, that we 
might work upon terminals, as for instance, the terminals of the fifth nerve 
which are readily reached in the face, and in that way get an effect upon this 
ciliary ganglion which is connected with the fifth nerve. Or, by working as 
we do, through the superior cervical ganglion to reach the third nerve, we 
might have an effect upon the ciliary ganglion, of course through its sympa- 
thetic connection. This will serve to show you how closely connected is all 
this nerve supply to the eye. One is quite dependent upon the other, and in 
affecting one you affect the other, provided it is in need of treatment. Thus 
you see that by working on this theory you can affect not only sympathetic 
life, but sensation and motion of the eye, since these nerves send branches to 
the eye. A little further with regard to the third nerve and its connection 
with the eye ball: It innervates all the muscles of the eye ball, as you know, 
except the external rectus and superior oblique. Through the ciliary gang- 
lion it also rules the sphincter of the iris. Howell's Text Book states that 
there are fibers antagonistic to this motor occuli from the ciliary ganglion, 
which constrict the iris and lessen the aperature of the pupil. The autago 
nistic fibers to this motor occuli come from the third ventricle, through the 
bulb, the cervical cord, the anterior roots of the upper dorsal nerves, the 
upper thoracic ganglion and the cervical sympathetic cord, and thus that it 
joins the ophthalmic division of the fifth iiei've, passing through its nasal 



107 

branch and its long ciliary branches to the iris. These antagonistic fibers, of 
course, must be dilators. Thus from the motor occuli you get the motor 
fibers to the sphincter of the iris and from the region I have just explained 
you get the dilator fibers of the iris. Hence, we dilate the iris by stimulating 
the superior cervical ganglion or stimulating in the upper dorsal region, moro 
particularly the latter. Quin, in speaking of fibres from the cervical gang- 
lion, notes these centers: dilator fibers arising from the 1st, 2nd, and 3d dor- 
sal nerves, then passing upward in the ascending branch of the superior cer- 
vical ganglion, reach the Gasserian ganglion, and the eye through the first 
division of the fifth nerve and the long ciliary nerves. He also says in par- 
enthesis that it is stated by many observers that the dilator fibers are con- 
tained also in the 7th and 8th cervical nerves. Motor fibers run from the 
higher four or five dorsal nerves. Thus you see along the cervical region, 
from the superior cervical ganglion down as low as the 6th dorsal you may 
get an important effect upon the eye. 

Concerning the fifth nerve, and its connection with the eye ball, I have 
already noted its connection with the ciliary mechanism ; that there are dilator 
branches from the cervical and upper dorsal through the nasal branch of the 
fifth, and that it has connection with the Gasserian ganglion. The ophthahnic. 
or first division of the fifth nerve, which is sensory in function, joins with 
branches from the sympathetic derived from the cavernous plexus. This nerve 
supplies the lachrymal glands, the conjunctiva of the lids and of the eye ball, 
and the skin about the lid and the face of that part. The fifth nerve is also 
very important in the nutrition of the eye, the face, and different parts of the 
head. Green's Pathology notes the fact that upon section of the fifth nerve 
keratitis or inflammation of the cornea arises, followed by ulceration. Kirke 
makes the same statment, and says further that the disease may progress so 
far as to destroy the whole eye-ball. Kirke also states that in the case of the 
fifth nerve, the fact that there are trophic fibers in it is proven by experiments 
of Meissner and Buttner, who found that division of the innermost fibers is 
most potent in producing decay. Howell's Text Book states that vaso-dilator 
fibers for the face and mouth are found m the cervical s}- mpathetics ; that they 
leave the cord at the second to the fifth dorsal; that they connect with the fifth 
nerve by passing from the superior cervical ganglion to the Gasserian ganglion. 
That other dilator fibers for the skin and mucous membrane of the mouth and 
face seem to arise in the fifth nerve itself, also some in the nerve of Wrisberg. 
He states further that excitation of the cervical sympathetic causes constriction ; 
excitation of the thoracic sympathetic, dilation of the retinal arteries. Thus 
you see that working from the cervical sympathetic, getting an influence along 
the path of the fifth nerve, you have a vaso motor effect upon the retina. So 
you have not only trophic but vaso-motor fibers in the fifth nerve, supplying 
the eye. Quain states further that the original fibers leaving the sympathetic 
at the superior cervical ganglion pass to the ganglion of gasser and to the eye 



108 

from the ophthalmic branch of the fifth through the gray root of the opthalmic 
ganglion and the ciliary nerves. Almost all of the fibers of the anterior part 
of the eye are found in the fifth nerve, hence, you can readily see the great 
importance that the fifth nerve bears to Osteopathic work upon the eye, because 
there is hardly any trouble in the eye whiclynay not be influenced through the 
nutrition, and such troubles are readily within the reach of the Osteopath. 

Taking into consideration the facts, then, we note first, that the eye is 
readily reached by the Osteopath in two ways; through its blood supply, and 
through its nerve supply. We note further that the chief points at which the 
Osteopath works to affect the eye are the third norve, the fifth nerve, the su- 
perior cerv'cal ganglion, the upper dorsal region, and also the ciliarv ganglion ; 
that, as I noted in the beginning, the superior cervical ganglion is the most: 
important point upon which we work in treating the eye, since, as you have 
seen, it is connected with the third and fifth nerves, and also with the ciliary 
ganglion. Also that through it you get an effect upon the iris, upon muscles, 
and upon nutrition and sensation in general. So that the Osteopath certainlyi 
is not lacking for means of reaching the eye. 

We note further that there is a constrictor center for the iris in the ciliary, 
ganglion and in the superior cervical ganglion ; that there is also a dilator cen- 
ter in the upper dorsal region and in the superior cervical ganglion. That is, 
dilator center for the ins. That is something that might be a little confusing. : 
that in the superior cervical ganglion you may have both a constrictor and 
.dilator center for the ins. However, Dr. McConnell states that we may con- 
tract th*^ iris by working at the upper cervical region, and that we dilate it by 
working down at the second and third dorsal. That has been our experience, 
and although there seems to to be a confusion of centers there, we go accord- 
ing to the results. We may work in one way upon the fifth nerve by treating 
the superior cervical ganglion, and we get an important effect upon the fifth 
nerve by .working upon its terminal branches. As I pointed out to you at the 
last lecture, the terminal branches of the fifth nerve are readily pressed ui)on 
at the supraorbital and infraorbital foramina, as well as at the mental foramen, 
and since we have shown that working ^upon terminal fibers is an important 
part of our work, and that through them we can gain important effects upon 
connected nervous mechanisms, I think it shows that we have a good opportun- 
ity to reach and effect the nervous mechanism of the eye through the fifth 
nerve. 

I noted also at the last lecture, the importance of ♦'xaminino- the neck in 
any trouble of the eye or part of the head. If there is any dislocation of tin- 
atlas or of the third cervical, these points ar(^ particularly significant m regard 
to eye troubles, or there may be an interference at the inferior maxillary articu- 
lation — a slip of that articulation, impinging from fibers of the inferior maxil- 
lary division of the fifth nerve, and since in that way vou may affect the whole 
nerve, it may have an affect upon the eye. 



109 

Byron Robinson quotes from Fox that, ''Irritation of the peripheral end of 
the cervical sympathetic will cause a protrusion of the eye ball, while section 
will cause a sinking of the eye ball." Dr. McConnell states that there are 
fibers which aid in the control of the metabolism of the retina at the f outh and 
fifth dorsal, and the strong stimulation of the sexual organs causes dilation of 
the pupils and protrusion of the eye ball. 

II. Further Landmarks in Regard to the Parts of the Head and 
Face. — According to Holden we notice the following points : You will readily 
feel the pulley of the superior oblique muscle by pressing the thumb just un- 
der the inner edge of the orbit. The seventh nerve has its exit from the cra- 
nium at the stylo-mastoid foreman. It then passes forward and runs into the 
parotid glands. It sends branches upward to the temple, toward the eye, the 
cheek, and jaw. The parotid duct lies on a line drawn from the bottom of the 
lobe of the ear to midwaj^ between the nose and the mouth, and empties op- 
posite the upper second molar touth. It is accompanied by a branch of the 
facial nerve supplying the buccinator muscle. The pulsation of the tempoial 
artery may be felt between the ridge of the zygoma and the anterior part of the 
ear. And it is said that that is a very convenient place to feel the pulse of a 
sleeping patient. The facial artery is very important in our work. It passes 
over the inferior maxillary bone at the anterior edge of the masseter muscle and 
also at the side of the nose high up. The coronary arteries are readily felt by 
placing the finger just beneath the lip against the mucous membrane ; you can 
feel them pulsate on the inner side of the upper lip and on the inner side of the 
lower lip. The facial vein, instead of taking a tortuous course to follow the 
artery, runs directly from the inne.* angle of the eye down to the anterior border 
of the masseter muscles. 

III. Examination of the Eye : — I took this subject up at the last lecture, 
but there are some other points that I wish to call to your attention in examin- 
jug the eye, An unnatural luster of the eye is seen in^fevers. An unnatural 
brilliancy is often found in consumptives. A glassy eye in children shows in- 
flammation of the mesenteric glands, and if it is accompanied by dark, dry lips 
and tongue and great restlesness, it shows an acute inflammation of the stom- 
ache. In fevers glassy eyes are a sign of great danger or of some serious 
change about to occur. Dull eyes are noticed in febrile conditions, during the 
catamenia, in catarrhal and other affections. Sunken eyes are due to the ab- 
sorption of the fatty cushions, and indicate some loss of the vital fluids ; hem- 
orrhage or some exausting disease. Exophthalmus, that is, protrusion of the 
eye ball, when not congenital, is said to be characteristic of Basedow's or 
Graves's disease. 

In your examination of the eye you should bear in mind and see what parts 
of the eye are affected, whether it is the lid, iris or conjuctiva, whether it is 
a change in the e3^e ball, whether the sight is affected, or there be weakening of 
the nerves, or inflammation of the eye. 



110 

IV. Treatment of the Eye : — As I have said, the treatment of the eye 
Osteopatbieally is qtiite a simple matter. There are certain points that I will go 
over to notice how we treat the eye. In the first placs, as I noted, we sometimes 
bring direct pressure upon the eye. We simply with one hand press gently up- 
on the eye ball, or you can lay your thumbs on it and press downward. In 
that way, as I explained to you, yon probably have an effect upon the cili- 
ary ganglion, yoa would also, of course, mechanically excite the blood supply 
by pressure. You would also have an effect through this pressure upon the optic 
nerve, since all these parts by being pressed back into the cavity would be more 
or less impinged upon. I also noted that we sometimes gently tapped the eye, 
laying one finger upon the eye, and with another, tapping three or four times 
very gently. The idea in that is Dr. Harry Still says, to shock the optic nerve 
and thus stiii^ulate it. Of course in that way also we stimulate the sympa- 
thetic, aud through them the blood supply. We frequently in treatment of the 
head tap upon the frontal sinus, not very hard, for troubles with a branch of 
the fifth nerve which supplies that sinus, and from it you might have a bad ef- 
fect upon the eye, causing some pain, which you might relieve in that way. We 
are frequently called upon to treat granulated eyelids. They are something 
that are readily treated by Osteopathic means, and something which are very 
distressing to the eye. We just wet the finger with a little water or some oil. 
sweet oil or vaseline and press it under the edge of the lid, both above and be- 
low, and then pressing with the thumb against the lid upon the finger, work 
with the thumb and finger along the edge of the lid, and in that way you stim- 
ulate the local blood flow; and the thickening there causing the granulations is 
said to be due sometimes to a local hypertrophy of the conjunctiva, or some 
times to a stopping of the ducts of the Meibomian glands. In thus working 
you would stimulate the blood flow to make that conjunctive normal or you 
would take away the stoppage of the ducts of the glands. Sometimes the se- 
cretion gets thick and stops up the ducts. I have often heard Dr. Hildreth 
speak of quite a noted case of granulated eyelids which were entirely cured. 
He said that Dr. Still explained that there was a stoppage of the circulatuui. 
that the blood had to make some use of the nutriment which was carried thi re. 
and instead of its being directed normally it was directed abnornuilly o\\ ac- 
count of the stoppage, and so caused these abnormal growths. What he did. 
was, as I have said, to free the circulation. Of course in any treatment o( the 
eye we must work over the superior cervical ganglion to get our effect upon tlu' 
circulation. 
Wk I spoke about i:>oints at which we can reach the tilth nerve. I^ai'ticularlN 
in work uj^on the eye we work at the supraorbital notch or foranuvn. here at 
the junction of the inner and middle third of the arch. He careful to fiHH' thai 
so that any contraction of the tissues about it are thoroughly rel ixinl, rheu 
the same thing should be done below, at the infraorbital l'oraiu;>;K Wc alsi^ 



Ill 

get a termination of the fifth nerve at the outer angle of the eye, and I always 
work carefully there and stimulate that branch of the fifth nerve. There is 
said to be a terminal branch just over the middle of the eye lid, and two ter- 
minal branches at the inner canthus of the eye on the nose, where we can 
readily impinge upon them. A terminal branch is found also uiDon each side 
of the mid-line of the forehead. According to the theory that we can work 
upon nerve terminals, as we frequently do, to gain an important effect ui)on 
the connected parts, we here have a number of terminal branches of the fifth 
nerve which we could certainly influence in that way to restore the normal. 
Of course at these places we also get the little blood vessels, here at the inner 
canthus and at the foramina and free them in our treatment. Another way 
that Dr. Harry sometimes employs almost exclusively in work upon the eye 
is to have the patint spring the mouth open while you hold the jaw; the idea 
being to free the blood supply through the carotids, since the blood supply of 
the eye is derived entirely from the internal carotids, and it is a very impor- 
tant point in relation to work upon the eyes. Of course we must not forget 
the point I mentioned in regard to the neck, and which you are familiar with; 
but the great and important point upon which we work, always remember, is 
the superior ganglion. Thoroughl^^ relax everything and remove every pres- 
sure which may affect the blood flow.- I showed you how to inhibit the action 
of the cervical sympathetic by holding. Of course stimulating would be the 
opposite — working quickly with alternate pressure and relaxation. 



LECTUEE XYIII. 

At the last lecture I took up points in regard to the eye, giving you 
"^arius centers, which I need not repeat here. Also I noted the importance 
of the ciliary ganglion in connection with the eye, the importance of the third 
nerve in relation with the eye, also of the fifth nerve in nutrition of the eye 
and parts of the head and face. Then I brought out certain points of 
importance to us as Osteopaths. I noted certain landmarks concerning the 
head and face; concluded the examination and took up the treatment of the 
eye. I wish to-day to continue our consideration of points about the head 
and face. 

I. Certain centers for the parts of the head. I have already mentioned 
some in previous lectures. Howell' s Text Book states that the cervical 
sympathetic contains vaso-constrictor fibers for the face, the eye, the ear, the 
salivary glands, the tongue, and perhaps the brain. As to vaso-motor 
nerves to the tongue; the lingual and glosso -pharyngeal nerves contain vaso- 
dilator fibers, while the hyi)oglossal and sympathetics contain vaso-constric- 
tor fibers. The chorda tympani, as already noted, is the vaso-dilator of the 
submaxillary gland. Quain states that the secretory fibers of the submaxil- 



112 

lary gland arise mainly from the second and third dorsal. Dana states that 
herpes, flushing, pallor, lachrymation and salivation all indicate some dis- 
turbance of the sympathetic and trophic fibers contained in the fifth nerve. 
Quain states further that the glosso -pharyngeal nerve through its small super- 
ficial petrossal branch furnishes secretory and vasodilator fibers to the 
parotid gland. 

In view of these facts, and of facts which I have already ]3resented, I 
wish to call the following points to your attention: First, that you have al- 
ready been show^n how to reach and treat the fifth nerve, the cervical sympa- 
thetic, the lingual, which is a branch of the facial, and the glossopharyngeal. 
I have brought up further the hypoglossal nerve, which is reached by the 
Osteopath at its exit from the skull at the anterior condyloid foramen, and 
also indirectly by the treatment of the superior cervical sympathetic ganglion. 
That the Osteopath thus controls the nerve supply of all parts of the head 
practically, and through the nerve supply the blood supply to the head, gov- 
erning, as he does, by his work upon the neck, the blood flow to all parts of 
the head, he must have an important effect upon its nutrition. A further 
point is that the Osteopathic work is very simply, and is made up largely of 
treatment in the neck, particularly at the superior cervical ganglion. I say 
very simple, because it is so in certain respects, but very complex when you 
come to study out the various complex relations of the nerves and the effect 
we may get upon them by working upon centers. 

II. Landmarks Holden instances the following points: The opening* 
between the eyelids varies in size in different persons, and it is this change 
and not a variation in the size of the eyeball which makes us say a person 
has a large or small eye, as the eyeballs are very nearly of the same size in 
different individuals. The external angle of the lid is generally a little higher 
than the internal angle, and gives an arch expression to the face. The closed 
lids fit accurately together, and are not believed, as sometinjes stated, to 
form a channel with the ball of the eye for the flow of the tears. Upon shut- 
ting the eye the ball turns slightly upward and inward, and in that way 
cleansing the cornea of any foreign substance which may have dropped u])on 
it, and also turning the pupil away from the light. The puncta lachryiuilia 
are familiar to you, they are seen at the inner angle of each lid. The 
lachrymal sac is found by drawing the eyelids outward, tensing in that way 
th? tendo oculi, which crossess the lachrymal sac about the middle. 1>> 
placing your finger upon the tendo oculi you can feel, by winking the e>(\ 
that the orbicularis palpebrarum and the muscles about the (\\t\ keep that 
tendon working so that the tears are pumped into tlu^ lachr> nial sac wnd 
passed into the nasal duct. The nasal duct is from six to<Mglr 1" les lonu, and 
X)asses from the lachrymal sac downward- It opens at tlu^ top i^l ilu' inferior 
meatus or sometimes in the outer wall. Tlu^ left nosti'il, > on will stM> u]u>n 



113 

examination is usually narrower than the right, owing to a deviation toward 
the left of the septum. It is important to you to know these points, so that 
you will recognize normal conditions and not conf ase them with disease. 
The middle and inferior spongy bones may be seen by dilating the nostril 
and throwing the head back. They are red in color and must be carefully 
distinguished from polypi. 

The Osteopath should also note the color of the lips, the normal Vermil- 
lion color indicating heath, and a departure from this indicating either the 
state of the circulation or condition of the blood. In looking into the mouth 
always bear in mind to look at the condition of the tongue, as it is a great in- 
dicator of disease. Upon the under surface of the tongue is a median furrow 
upon each side of which is the ranine vein . In the middle line of the floor of 
the mouth is the frenum linguae, upon each side of which is the opening of 
the duct of Wharton, leading from the submaxillary glands, which you may 
find beneath the mucous membrane back near the angle of the jaw. The 
sublingual glands are in the ridge of mucous membrane each side of the mid- 
dle. The shape of the hard palate is sometimes signifigant, usually a broad 
arch, sometimes narrower at the top like Gothic arch, and it is said that in 
idiots it is quite sharp. 

In examing the throat it is a good plan, it is said, to hold the nose so 
that the person is obliged to breath through the mouth. That will cause a 
dilation of the varous parts of the throat and a widening of the fauces and a 
raising of the soft palate, so that you can then get a good view of the internal 
parts of the throat. When you depress the tongue it should be done gently 
with your finger or the handle of a spoon or something of that kind; if you 
are rough the tongue will resist the effort you are making to lower it. The 
operator can pass his finger down into the throat past the epiglottis as far as 
the inferior border of the cricoid cartilage; as far as the beginning of the 
oesophagus, and can make out the greater cornua of the hyoid bone and seek 
in the hyoid spaces on each side where any foreign body is queit apt to 
lodge. It is important to know sometimes that behind the last molar tooth 
there is a small aperature through which a little tube may be introduced 
through which to feed a patient in spasmodic closure of the lower jaw. The 
place where the surgeon taps the antrum is just above the second bicuspid 
tooth about an inch above the margin of the gum. The aperature of the pos- 
terior nares may be felt by passing the finger carefully up behind the soft 
palate, and there can be made out by the touch the back of the septum and 
the back part of the inferior spongy bone in each nostril, also a grasping 
feeling from the action of the superior constrictors of the pharynx. 

I have already spoken concerning the tonsils. They lie at the side of the 
throat just behind the pillars, and in examination of the throat if you see 
them extending beyond those pillars, it shows they are abnormal in size. 
The normal tonsil does not extend beyond the level of the pillars. 



114 

I have mentioned physiognomy in relation to examination of the face. It 
is stated that the insertion of the muscles, not only into tendons and bony 
parts of the face, also into the skin all over the face, leads to the formation of 
lines. That the passage of various thoughts through the mind constantly re- 
curring, calls into play certain sets of muscles, and finally leaves lines upon 
the skin at the places of contraction, thus creating a reliable method by 
which the countenance may be read, and which is sometimes useful to us. 
There are two of these lines which I wish to mention particularly. First, 
there is the linee nasalis, extending from the alse nasi out to the angle of the 
mouth. And it is said that in children its presence denotes some abdominal 
trouble, especially inflammation of the bowels; in older persons some trouble 
with the stomach or abdominal disease, frequently of the liver. The linae 
labialis extends from the angle of the mouth down to the side of the Jaw. It 
is seen frequently in children with inflammatory diseases of the larynx or 
lungs, and in older people who have laryngeal and bronchial trouble, and 
difficulty of breathing. Of course the Osteopath, as well as the physician, 
should become familiar with the indications of the face, know its natural tem- 
perature and different things about it. I cannot mention such things now, 
but they are interesting to study and are very practical in directing the oper- 
ators attention to the probabilities of disease — it is very helpful in diagnosis. 

I wish to-day to examine further the parts of the head, and show you the 
treatment to be given. 

III. Examination of the Ear. The disease may be in the external, in 
the internal, or in the middle ear, or it may be in the brain or in the auditory 
nerve itself. It is sometimes very difficult to say where the location of the 
disease is. First: As to examination of the external auditory canal. Since 
it runs forward and inward and is slightly curved, you must draw the auricle 
upward and backward to be able to look down into the external canal. You 
must have a good light. You can look directly in without the aid of any 
instrument, but usually the operator should be supplied with an ear speculum, 
which is a little tube, funnel shaped, polished so as to reflect the light. 
Frequently a forehead mirror is used; a little mirror that is fastened by a 
band about the forehead with an aperature in the middle, through which the 
operator may look. This reflects the light, and reveals the interior of the 
canal. In looking into the external ear you may notice that there is too much 
or too little wax, indicating some general disease. You may notice that 
there are growths in the ear, or foreign bodies, such as buttons in cliildtMn's 
ears, or insects, or the wax may become hard and impacted. 1 had a casi' 
once in which a person had noticed a slight deafness continually increasing 
until finally he was not able to hear his watch tick when held at his oar. 1 
found by examination that the wax had become impacted. Of course lie 
could hear internally by certain methods em])loyed to test the hearing. 1 just 



115 

took the curved end of a hair pin and picked out the wax, and he could hear 
all right. It is quiet a common thing in persons who have a poor quality of 
blood to have furuncles, or boils, in the external auditory canal. Your ex- 
amination of the ear will reveal to you the membrani tympani, which should 
appear concave. It is in color a pearly gray and glistens with the reflection 
of the light. You can see the j)rocessus brevis of the malleus and the manu- 
brium of the malleus, and you can sometimes with a good light see the pro- 
cessus longus of the incus. The membrane appears concave; the most con- 
cave part at the end of the manubrium, is called the umbo; at the ti]3 of the 
manubrium appears a bright triangle or pyramid of light where the reflection 
is brighter than at other parts. Of course only practice will make you fa- 
miliar with the normal external parts and appearance of the membrane. 
Further, you should always in examining the ear look for perforations, of 
the membrane because those frequently occur in ear troubles. 

As to the middle ear, you may have it affected by different diseases, 
among which are inflammations, catarrhs, etc., in which case pus or mucDus 
may collect in it. In that case, if the ear were filled with pus or mucous, 
the membrane would be pushed outward, and would be convex instead of 
concave. By examining from the external ear, if inflammation were present 
there would be a reddish appearance of the membrane. It is said the pres- 
ence of mucous or pus gives a yellowish tinge to the membrane. For ex- 
amination to see whether or not the Eustachian tube be closed there are differ- 
ent methods used. One is for the patient to close his nose and mouth and 
make an expiratory effort, eliciting a crankling sound of the membrane, due 
to the impact of the air. That is called Yalsalra's method. Another method, 
called Politzer's, is practically the same. The patient is directed to swallow 
a little water, the operator having introduced a tube through one nostril, and 
closing the mouth and both nostrils except the tube, through this tube the 
operator blows, and the air is forced up towards the membrane, and in case 
the membrane is perforated there is a whistling sound as the air escapes. Or 
if there is an accumulation of pus or fluids, they will be driven into the ex- 
ternal ear. In case 'of closure of the external ear it is said that there is an 
magnification of the sound in the middle ear, or in case of closure of the 
Eust achian tube the same thing would obtain, or in case there was too much 
secretion about the ossicles, not allowing free motion. In such cases it is 
said if a tuning fork is placed on the mid-line of the top of the skull, or 
against the teeth, the sound is increased in the affected side. If it is heard 
louder in the other ear, it indicates some trouble with the internal ear of the 
affected side. Your diagnosis may be made still closer bj* placing a watch or 
tuning fork against the mastoid process of the affected ear; if there is no re- 
sponse you may be sure the trouble is in the internal ear. Those are a few 
methods by which you may determine where is the trouble that is affecting 



116 

the ear. Since the aurist makes the ear his life time work, we cannot do 
justice t3 the subject in any one or two lectures. 

IV. Treatment of the Ear — I have already shown you how to ex- 
amine the external canal of the ear; the usual methods are employed to re- 
move foreign substances, or in case of impacted wax you had better use some 
warm water; it may take several sittings to remove it entirely, and the 
hearing may be worse after the first treatment with the water because of the 
swelling of the wax filling the canal. In the case of in sects in the ear some 
warm water or sweet oil may be introduced with a syringe. In ear affections 
there is usually trouble with the atlas or in the upper cervical region. We 
treat then the lesion, if we find it, in the neck, and we treat the ear largely 
by regulating the blood supply; by springing the jaw, as already shown. 
The chief work in the neck is on the superior cervical ganglion, and in stimu- 
lating the blood flow through the carotid arteries. Of course in affections of 
the ear from catarrh or constitutional troubles you would have to direct your 
treatment to the general condition of the patient — look after his general 
health. I had an interesting case of deafness once where I did not treat the 
ear at all. I found the clavicle was slipped; that. the scaleni muscles were 
hard; that there was a paresis of the right arm. I slipped the clavicle back, 
treated the scaleni muscles, and the lady went up stairs and immediately called 
down that she could hear the clock ticking downstairs, something she had 
not done before. It must have been by sympathetic connection of the nerves 
which had been affected; the brachial plexus and the nerves to the ear. I 
do not know of any other way to account for it. That shows you cannot 
always work according to rule, but you must look for the cause and treat 
wherever that may occur. 

Examination and Treatment of the :N"ose: — Since the aperature of 
the nostril is on a little lower level than the bottom of the passage of the 
nostril, you have to pull the nose up and back. You can dilate it with 
a speculum used for the purpose, and you can use either form of reflected 
light- You may see the middle and inferior turbinated bones and the marks 
I have mentioned. You will learn to recognize the normal conditions, and 
to note any diseased conditions and observe whether there are any growths 
in the nose; the polypus is the most common. It is common to meet with 
fractured nasal bones. That of course belongs to the surgeon, but is very 
readily set. You can diagnose this condition by holding the ear close and 
you can hear a grating sound as you move the nose. I have had cases in 
which I woukl simply straighten out the parts, using no splint or anything 
of that kind. I do not know wliat is the usual method surgically, but with 
no splints the bones willl stay in position and no deformity or abnormality 
follow. You will sometimes notice that in catarrh, on account of the absor]v 
tion of these turbinated bones, the nose is deflected to one side ov to the oth- 



117 

er. The usual way in which we treat the nose, aside from the general sys- 
tem which is adopted in catarrh, the freeing of the blood supply in the neck 
and of the blood supply about the nose, is to work on the outside of the nose 
and loosen all the tissues along the side. In that way also you free the nasal 
duct by loosening all the tissues. Also in case of stoppage of the nose in 
colds and catarrh, we place the hand flat above the frontal sinuses and press 
down quite hard. You can sometimes clear the nostrils in that way so that 
the stoppage is gone and the breathing is clear through the nostrils. There 
is another disease which you frequently meet, a ringing in the ear, tinnitus 
rurium. It is common in old people, and it is common also in constitutional 
diseases, after sunstroke, or in malnutrition, and old age. Therefore, it arises 
sometimes from conditions of general health. The Osteopath has found that it 
is due, in some cases, to a stoppage of the circulation in the little anastomosis 
on the ear drum, and he- then works in the usual method to free up the carotid 
artery, and by stretching the jaw. Sometimes the trouble is in an obstruction 
to the auditory nerve. It is said that we inhibit the auditory nerve b}^ pressure 
in the neck opposite the third cervical, by steady holding there. 

I cannot mention m such a lecture as this ail the points in connection with 
examination of the mouth and throat. That also is a field for the specialist. I 
have noted that jon should see the condition of the tongue, whether it is 
furred, what its temperature is, and its color. These are very indicative. For 
instance, it is said that a furred tongue is indicative of a one-sided disease, as 
instance of the liver or spleen. A furred tongue has been noticed by Hilton in 
a case of ulceration of the teeth. The half of the tongue on the side of the 
mouth affected by the tooth was furred, and there was stiffness of the jaw. Of 
course he referred it to the fifth nerve, which supplies the muscles of the jaw 
and suppHes also a part of the tongue. As to the color of the tongue, we 
might mention for instance, the strawberry tongue, as it is called, in scarlet 
fever, or the lead colored thrush-covered tongue in the dying. 

You will observe the tonsils, the uvula and the condition of the fauces. 
Frequently in diseases of the throat the uvula is inflamed or edemetous and is 
hanging down, obstructing the passage of the air, and keeping the patient con- 
tinually coughing. There are certain times when we give internal treatment 
to the mouth and throat, but not very frequently. That is, in case of catarrh, 
tonsilitis. or something of that kind. We sometimes insert the fingers and by 
a prerssure upward and outward along the pillars of the fauces, we free the 
circulation to those parts, and can in that way to a considerable extent allay 
the inflammation. That is, we frequently relax congested and contracted 
parts. The general treatment for the throat I have shown you, by loosening 
the muscles and by working to free the blood supply, but 3^ou must also be 
sure that all the muscles throughout the neck are relaxed. You can feel those 
in the back of the neck, as I have already shown. You cannot, however, feel 



118 

the anterior spinal muscles in the neck, you must take into consideration the 
probability that where others are contracted, they also are, and adapt your dif- 
ferent motions to the stretching of those muscles; simply by stretching the 
head backward you can free all the branches of the nerves. 

There is a great deal more that might be said both in general and in parti- 
cular concerning the eye, ear, nose, throat, and parts of the head, but I think 
that in the three lectures that I have given you I have been able to give you the 
usual Osteopa*.hic treatment for the parts of the head, and to give a general 
idea of the importance of these things. Of course we depend entirely upon the 
nerve and blood supply. That after all is the best part of the work. 

Q. In regard to exammation of the nostril, vou said we should observe 
the turbinated bones. Is there any way by which you can remove abnormal 
growths from that bone osteopathically? 

A. That bone is very frequently softened by catarrh, sometimes ulcerated 
and eaten away, and in so far as you can influence catarrh, with which we have 
good results, you could influence this other trouble, and by work upon the nose 
you might gradually work the parts back into their normal condition. 

Q. You spoke of dropping of the uvula, is that not caused largely by 
catarrh ? 

A. Yes, sir, in general. Anything which would inflame, of which catarrh 
is a sample. 



LEOTUEE XIX. 

At the eighteenth lecture I considered certain Osteopathic points about the 
head, giving you certain centers for the head and its parts, which I need not re- 
peat here ; something concerning the vaso motors, that the Osteopath had there- 
fore a good fleld upon which to work in treating the head and all its parts, the 
brain included. I then instanced certain landmarks, and took up further the 
subject of how to examine the parts of the head, including the eye, nose, throat 
and mouth. I wish to-day to call your attention further to the thorax and its 
parts. We have so far in our Osteopathic work seen how to examine the spine, 
neck, head, etc., the significance of points discovered; also how to treat them. 
It is of great interest to us now to go to the thorax. And in going to the thorax 
it is quite fitting that I should say something in particular about the splanchnic 
nerves. I have said something concerning these nerves already, but think 
something more in particular would be of value to you. The splauchnics, as 
you probably already know, are some of the most important tools with which 
the Osteopath works, and I will venture the assertion that there will be hardly 
a day in your practice pass without your working upon the splanclinics. They 
are of such far reaching connection that their importance at once becomes ap- 
parent, hence, their constant use by the Osteopath. As to definition, you know 



119 

what splanchnology is — the science of the viscera. Hence, the splanchnics, 
refers to visceral nerves, those nerves governing the viscera, and it is in this 
fact that their significance lies. It is with the sympathetic splanchnic nerves 
that we as Osteopaths have to deal, and it is because of their far reaching con- 
trol of visceral life and the wonderful results the Osteopath can get in working 
upon them, that he has been so successful in treatment of diseases in general. 
That is one of the reasons, I should say. 

Now, as to what these nerves are, we know at once that they are the 
sympathet^cs from the lateral chains of thoracic ganglia. I want to bring out 
a few points concerning these nerves by way of review, so that we will know 
what we are working with. First, the great splanchnic arises from as high as 
the fifth or sixth, and from all of the thoracic ganglia below down to the ninth 
or tenth. It perforates the diaphragm and joins the lower part of the semi- 
lunar ganglion. In the chest it sometimes divides and forms a plexus with the 
smaller splanchnic. As to the nature of these fibers, they are white, medul- 
lated fibers. You remember in one of the first lectures I called your attention 
to the fact that in the sjanpathetic there are two kinds of fibers. And it is 
stated by Quain that about four-fifths of the fibers of the splanchnics are made 
up of white meduUated fibers, and they come direct from the anterior roots of 
the spinal nerves. This greater splanchnic may arise as high as the third 
thoracic. Gray, I believe, states it may receive branches from the upper six 
thoracic. This greater splanchnic gives branches in front to the aorta itself 
and to the front of the vertebrae. 

As to the smaller splanchnic, it arises from the ninth and tenth, as usually 
described, sometimes from the tenth and eleventh, thoracic ganglia.. Or, it 
may not arise from the ganglia, it may arise from the sympathetic cord itself 
without the intervention of ganglia. It also passes through the diaphragm, 
sometimes separately, and sometimes in conjunction with the cord of the 
greater splanchnic. It also joins the lower part of the semi-lunar ganglion, 
and sends branches to the renal plexus in case the renal splanchnic is wanting, 
or in ease it is small. 

The smallest or renal splanchnic, as you gather from the above, is some- 
times wanting. It arises from the last thoracic ganglion, and passes 
through the diaphragm in connection with the general sympathetic cord, and 
goes to the renal plexus, not the semi-lunar ganglion. 

A fourth splanchnic is sometimes described. It is stated that Wrisberg 
in eight instances out of a great many found a fourth splanchnic is the cervical 
region. 

We all understand what is meant in general when we speak of 
the splanchnics. That is, these, three splanchnic nerves. But you will 
see that it is sometimes used in a different sense. Gaskell, quoted by Quain, 
says that there are visceral branches from the second, third and fourth sacral 



120 

nerves, and these he calls the ''sacral or pelvic splanchnics." "The cervico- 
cranial rami viscerales" are visceral branches from the spinal accessory, pneu- 
mogastric and glosso-pbaryngeal and facial nerves. So you see that visceral 
nerves have their origin from these cranial nerves ; also a branch from the 
ciliary ganglion from the third nerve. Byron Robinson has this to say con- 
cerning splanchnics in general. "There are certain fine white medullated 
nerves, wliidh Gaskell mentioned, and which pass from the spinal cord in the 
white rami coramunicantes between the second dorsal and second lumbar nerves 
inclusively, to supply viscera and blood vessels. These nerves should be called, 
as Gaskell suggests, splanchnics. Hence, we will have, first, the thoracic 
splanchnics ; second, the abdominal splanchnics, and third, the pelvic splanch- 
nics. Hence, you will see the general use to which Gaskell put the term, in 
the use of which the other authorities have concurred. Robinson says further, 
that these white rami communicantes extend from the second dorsal to the sec- 
ond lumbar, but we know that along this region and in the region above the 
second dorsal and below the second lumbar, gray ones are found. 
In the last two named regions gray exclusively. That variety he calls 
peripheral, supplying the parietes of the body. From the foregoing, and what 
has been said in general concerning splanchnics, we see that the splanchnics 
proper of which we speak, are white medullated fibers, for the most part, and 
that their particular function is to attend to the blood vessels and to the viscera. 
Flint says that the splanchnics are the most important vaso-motors of the 
system. And further, Quain states that the medullated fibers, that is, such as 
we find in the splanchnics, which pass in the sympathetic system, are classed 
by Kolliker as (a) sensory, (b) vaso and viscero constrictors, and (c) vaso and 
viscero-dilators. Hence, we have passing from the spinal cord along into the 
great prevertebral plexuses in the different regions these sensory, vaso-dilators 
and contrictors and viscero inhibitors and constrictors. He goes on further to 
say that the sensory are found only passing from the cranial nerves, but that 
these visceral and vaso-motor fibers are found all the way down the cord. 
Hence we see at once that these visceral and vaso-motor branches are found in 
the splanchnics. In line with the above Quain says further, that the splanchnic 
nerves proper, act first, as viscero-inhibitoiy fibers for the stomach and intes- 
tines ; second, as vaso-motor fibers to the abdominal blood vessels; third, as 
afferent fibers from the abdominal viscera. That is, fibers from the abdominal 
viscera back to the center. And that explains why it is that we get secondary 
lesions, as we call them. You may have some trouble in a viscus somewhere, 
and knowing that you have afferent fibers from the viscus back to the center. 
you can account for the center being affected, and the impulse coming out 
from it to the i)Osterior spinal nerves, for example, and causing constracturo 
of the muscles in the back. I have already said enough to show you ihe im- 
portance of the splanchnics — to show you in geueial their nature ami fuuc- 



121 

tion. They become still more significant to the Osteopath when he considers 
their connections with the other parts of the sympathetic system. In the first 
place, they must be connected with the spinal cord itself, since they arise 
from the anterior roots, and, through the cord, with the brain. It is doubt- 
ful how close a connection they have with the brain centers, but they have at 
least a close connection with the bulbar center, the vaso constrictor center 
of the medulla. Then it is probable that these splanchnics have a close con- 
nection also with cardiac and pulmonary fibers arising from the upper part 
of the spinal cord; because we have seen that the center for the lungs extends 
from the second to the seventh dorsal, and that we work in the upper dorsal 
region for the heart, and there are certain vaso motor fibers from these re- 
gions to the heart and lungs, so that it is almost undisputable that there is a 
connection between the splanchnics and what we might call other splanchnics 
for the heart and lungs. In the next place, we have seen that the first two 
join the semi-lunar ganglion and the third the renal ganglion. And they are 
connected directly with the solar plexus, and through it with the other great 
prevertebral plexus, the hypogastric plexus, and through that with those lit- 
tle secondary plexuses, such as the superior and inferior mesenteric, hem- 
orrhoidal, portal, Auerbach's and Meissner's, and the various plexuses 
throughout the pelvis and elsewhere. Hence, anyone who sees the signi- 
ficance of osteopathic work will see the significance of this far reaching con- 
nection with visceral and organic life. Then, again, remember, that in the 
thorax the first or greater splanchnic sends branches directly to the aorta it- 
self. Hence it is that the operator so frequently works upon the splanchnics; 
it does not make any difference what kind of trouble you may have, your gen- 
eral health is likely to be affected, and it must be attended to; and whether 
you are working upon the stomach, liver, portal system, upon the intestines, 
or pelvic viscera, you will work at least in part upon the splanchnics. 

There is a second sense in which we mast consider the use of these 
splanchnic nerves, and we may state the matter this way: That work upon 
the splanchnic nerve is frequently a regulative process. I might illustrate what 
I mean by that. Here you have a set of sympathetic nerves, they are vaso- 
motor nerves for very important parts of the body, viz : the internal viscera, 
which receives an exceedingly large blood supply. If the osteopathic ability 
to work upon the nerve centers and nerve connections stands for anything, it 
must certainly stand for something when it goes to work upon these splanch- 
nics. Hence, he must have a large control throughout a gieat portion of the 
circulation of the body since it is so richly supphed from these nerves. Here 
you have a quantity of blood in the body ; we will say in a certain case it is un- 
equally divided. The Osteopath's work is sometimes to equalize the circulation 
throughout the body. In case you have a headache, which is frequently a con- 
gestion in the cranium, what do you wish to do? You wish to regulate the 



i 



121 

circulation. You must therefore employ some regulative process, and very 
frequently we work upon these splanchnics to throw this congestion somewhere 
else where it will do no harm. Another thing, the most natural place for the 
overplus of blood to go is in the abdominal veins. Green makes the statement 
that the abdominal veins are the most easily dilated, and while I cannot exactly 
quote from him, I believe he goes on to say that the over-plus of blood is most 
readily thrown there. At any rate I can state it is my experience that we can 
get important results by throwing the congested blood to the abdominal veins, 
and we do cause another congestion there. Not long ago 1 had a case of head 
ache ; it came from prolapsus. The lady had vomited, and had had trouble 
with her stomach and trouble s^enerally. I gave the usual treatments, as I al- 
ways do first, working about the region of the stomach and liver and over the 
splanchnics, as it looked as if the case at first might be a case of sick head ache, 
later she told me it was from prolapsus. I then treated all about her head, but 
the head ache did not go until I finally pressed deeply over the region of the 
solar plexus. By deep pressure there until you can feel the pulsation of the 
abdominal aorta, you will get important results very frequently. In other 
cases I have relieved head ache by simply pressing there. Now, wheather that 
was simply inhibition over the solar plexus, and thus to the brain, and thus 
quieting the painful sense, I could not say, but it looks to me more likely that 
it was a regulative process which inhibited the solar splanchnic and allowed 
the blood to come to the veins of the abdomen, and thus relieved the congestion 
in other parts. There is another thing tnat I frequently notice in my practice, 
that is I get effects upon the circulation of the body by a general spinal treat- 
ment, which of course involves work upon the splanchnic region. And I can, 
by working there, coupled with the usual treatment I give the heart, get better 
results in quieting the pulse than I can by other methods. It seems to me it is 
because I get a dilation of the vessels in general thoughout the abdominal 
viscera, hence lessening of the tension and slowing of the blood flow follows, 
and a quieting of the pulse. A case of the same kind might be mentioned 
where a congested uterus was relieved by work over the splanchnic region. 
How we reach and treat that region I will show you in detail in the third part 
of the lecture. 

In line with what I have stated, Howell's Text Book says that visceral 
changes produced reflexly in the splanchnic area are of especial importance bo- 
cause of the great number of vessels innervated through these nerves, and the 

great changes in blood pressure that can follow dilation or constriction on so 
large a scale. Some one asked me some time ago how we worked to cure :i 
cold. I told him that was a matter of general treatment which 1 shall take up 
later. However, we give a spinal treatment, drawing the congestion from the 
part affected, which is very frequently the head, and give relief. That is. we 

work upon a large amount of blotul controlled by the splanchnii's. and tluis 



122 

draw it away from the congested part. We thus see that it is a very probable, 
and, in view of the facts it is quite likely the case, that the Osteopath can al- 
most at will throw large quantities of blood to the abdominal region, or away 
from it, by proper treatment. I mio^ht state in passing that it is a principle 
that we might take notice of that in a case of congestion it is a good plan to 
divert the congestion to some other part where it will do no harm. We stated 
the other day when the matter was brought up that the way to treat it was to 
sweep it out by freeing the arterial blood flow to the part. I am indebted to 
Dr. Conner for the suggestion that it is well to divert the congestion to a part 
where it will do no harm. I saw him treat a case some time ago, an old lady 
with a very troublesome cold in her head, which gave her headache and caused 
her a great deal of trouble. She had been treated for some broncial trouble 
and the pain had left the upper part of the chest and she thought the conges- 
tion had been forced into the head. Several had treated the case unsuccess- 
fully. Dr. Connor just came in and raised the clavicle and twisted the see a time 
or two and went out. I saw him later in the hall and asked him about it. He 
said ^' I just lifted that clavicle and sent the congestion down the arm 
where it would do no harm." I think we very frequently use the method and 
throw the blood somewhere else, but when it is thrown somewhere else I do not 
believe it is congestion. Howell's Text-book says further: "Anemia or 
asphyxia of the brain stimulates the cells composing the center, that is the 
vaso-motor center, and more blood enters the cranial cavity where it is needed. 
Doubless the splanchnic area plays an important part in this restoration pro- 
cess." Hence we see from that, in the first place that the Osteopath may by 
his appropriate methods influence the blood in the splanchnic area by work 
upon the vaso-motor area in the medulla. And -since it is a poor rule that will 
not work either way, he can do the reverse. That is, he can affect blood flow in 
the head by work upon the splanchnic direct. Our conclusions may be ex- 
pressed under two heads : First, that in work upon the splanchnics the Os- 
teopath works upon them for the effect that it gets upon the connected viscera 
supplied by those splanchnics. That he works upon them in a secondary man- 
ner frequently for regulation of blood currents to the body generally or in 
some particular part of the body. 

II. Landmarks. — According to Holden: Since the heart and lungs are 
contained in the thorax, and since adnormalities of parts of the thorax may 
cause serious troubles with these important viscera, and since the Osteopath 
finds so many things upon which to work about the thorax, I hardly nesd to 
say to you that it is important that we know the landmarks of the thorax 
thoroughly. I have given you some in connection with the spine, but you 
will notice the following: As a rule the right side of the chest is a little 
larger than the left and you should bear that in mind in making your ex- 
amination. In the female the sternum is shorter, and the upper ribs are more 



123 

movable, and the upper aperature of the sternum is on a level with the sec- 
ond dorsal vertebra, is quite narrow, rarely exceeding two inches. Behind the 
first bone of the sternum there is no lung tissue. The left vena innominata 
crosses behind the sternum about an inch below the top. Next come the 
great primary branches from the aorta. You get deeper in this region the 
trachea bifurcation at about the level of the junction of the first and second 
parts of the sternum; and deepest of all lies the oesophagus. On the bifurca- 
tion of the trachea and about an inch below the upper margin of the sternum 
lies the highest part of the arch of the aorta, which curves on over the left 
bronchus. The course of the innominate artery corresponds to a line drawn 
rom the middle of the junction of the first and second bones of the sternum 
to the right sterno- clavicular articulation. All these are interesting to know. 
Here is something that is absolutely essential to know: 

Eules for counting the ribs: In passing your fingers down the sternum 
in front you can readily detect where the first part ends and the second part 
begins. Here is the junction of the cartilege of the second rib with the 
sternum. The first rib is found by feeling behind the clavicle above. You 
can, by deep pressure, come to the first rib. The first and second ribs give a 
great deal of trouble, and it is important to keep in mind this rule to find 
them. In the male the nipple is usually between the third and fourth ribs 
three-quarters of an inch external to the line of their cartileges. It is said 
that the lower external border of the pectoralis major corresponds in direction 
with the fifth rib, that a horizontal line drawn from the nipple right around 
the body will cut the sixth intercostal space at a point midway between the 
sternum and the spine. When the arm is raised the highest visible digitation 
of the serratus magnus corresponds with the sixth rib, and the seventh and 
eighth digitations correspond with the seventh and eighth ribs below. I have 
already noted that the scapula lies on the ribs from the second to the seventh 
inclusive. The eleventh and twelfth ribs are readily recognized, even in 
fleshy persons, at the outer edge of the erectors spime, sloping downward. 
The sternal end of each rib, of course, as you know, is lower than the end 
which joins the spine, and it is said that if a horizontal line was drawn from 
the middle of the third costal cartilage at its junction with the sternum, iv 
would touch the body of the sixth dorsal vertebra. The end of the sternum 
is upon a level with the tenth dorsal vertebra, its length varying some in dif- 
ferent individuals, more in females than in males. 

III. (a) How to treat the splauchnics. (b) How to examine the thorax. 
There are various ways in which we may treat the splancliiiics. One of the 
best ways to treat the splanchnics, especially the renal splauchnics, is to have 
the patient on the back, everything being relaxed. If you are afraid that tlie 
psoas muscles will not be relaxed, you can raise the limbs, and then ever> 
thing cei'tainly will be. And then, by reaching under and raising the ]>atiiMU 



124 

on the tips of the fingers, we can get one of the most important effects upon 
the splanchnics, especially the renal splanchnics. Dr. Harrj^ treats in that 
way almost entirely for the kidneys. We may also treat the splanchnics by 
having the patient on the side and springing up the spine all the way along 
the region of the splanchnics. Also, one way you can work is by loosening 
up all these muscles, or you might have the patient upon the face and work 
as I have already shown you, and this restricted particularly to the splanch- 
nic region will stimulate the splanchnics. There is one more important way 
in which we reach the splanchnics, and it is something we apply usually to 
the treatment of the liver, which of course must be done directly over the 
splanchnics. In treating the liver I always end up in this way, reaching 
over with the left hand I get it against the angles of the ribs, bent in this way 
to make a fulcrum of the hand. Then, having hold of the arm of the patient 
just below the elbow, I push it up and back near the head and then back- 
ward; that raises the ribs, and of course it gets an effect also upon the 
splanchnics, that is, directly; it will also act mechanically in freeing the ribs 
here and giving the liver more space in which to work. Once more as to how 
we can reach the splanchnics in front. This is the motion I use just here at 
the front; deep pressure until you can feel the pulsation of the abdominal 
aorta. It is apt to hurt some patients quite a little, you will have to be very 
careful, some it will not hurt much, and if you do it gently and have quite 
a prolonged pressure there, you can often get the most astonishing results. It 
is said also that this pressure treatment here is very good to condense gas in 
bloating of the abdomen. 

As to the examination of the thorax, it is quite a long question, and I 
will have to let some of it go over until the next lecture, but I might call your 
attention to the importance of making very careful examination of the thorax. 

In examining the thorax you should have the patient lying lying flat 
upon his back. First, remember that the right side is usually a little larger 
than the left. You should by inspection, next the skin if possible, see that 
both sides are about the same size — that one does not bulge more than the 
other. You will find important changes in the shape of the thorax. For in- 
stance, I saw a case of enlargement of the heart from cigarette smoking, there 
was a perceptible bulge in the precardial region. In ano^"her case, of asthma, 
I saw quite a bulge upon the right ride along the region of the upper ribs. 
Also see that when the patient is standing the thorax is in shape; that is, that 
one side is not dropped more than the other. Some times we will find one 
side of the thorax dropped. It is proper in making your examination, espe- 
cially by palpation, to put both hands upon the part, so that you involun- 
tarily compare the parts. If I were examining this thorax upon the left side 
particularly, I would put my left hand upon the side opposite, so that I could 
CO mpare the parts as I work over it. 



^ 



126 

Of course to examine in front and behind. Then you put your hand over 
the surface of the skin to detect any departure from the normal temperature. 
I have already noted the importance of that in examination of the liver; in 
conditions resulting from diseased liver it is said that very frequently cold 
spots are found upon the surface of the body. However, you will have to be 
a little careful on a warm summer day, a person being in a state of perspira- 
tion the skin will cool very rapidly. Then you should observe the shape of 
the thorax — whether the general shape be normal. In an infant you will find 
it cylindrical. In asthma and emphysema you will find the characteristic 
barrel-shaped chest. In what is known as the paralytic chest the antero-pos- 
terior diameter is lessened and the chest is flattened. I have already men- 
tioned that to you in cases of neurasthenia. The rachitic chest is flattened 
upon the sides. Also look closely at the sternum. It may be abnormally 
protruded or retracted, or there may be malposition at the junction of the first 
and second parts, and the ensiform appendix may be deflected to one side. 

Finally, look at the clavicle and the coracoid process. You know where 
to find the coracoid, on the front part of the shoulder at the origin of the 
coraco-brachialis muscle. It is easily found. Sometimes the fibers of the 
deltoid get caught below it, sometimes the fibers of the brachial plexus. The 
clavicle may be up or down at either extremity. You will acquaint yourself 
with the normal feeling here at the junction of the clavicle with the scapula 
and will readily detect when it has slipped up or down. You can also see if 
it has slipped down by seeing whether it is close to the coracoid process at 
the scapular end, you will recognize whether it corresponds with the normal. 
At the upper part of the sternum, the clavicle sets up quite prominently. It 
may slip down or be too high up, and you must learn to look for all these 
things carefully. 



LECTUEE XX. 

At the last lecture I considered especially the splanchnic nerves, show- 
ing you their origin, that they arise from as high as the third dorsal down to 
the twelfth; that they were composed, largely at least, of white medullated 
fibers; that they were closely connected with the cord, since they arise from 
the spinal nerves themselves, and with the various visceral plexuses, also, 
which rule the organic life; that they were extremely imx^ortant in the work 
of the Osteopath, and that since the general health was so often involved in 
the troubles of the viscera, thei'efore he worked upon them very fi-equently: 
the fact that he worked usually directly for the benefit of the action he would 
get up on abdominal life, and that also he frequently worked in a regulative 
way, using the splanchnics for vasomotor control largely, thus intluencing 
arge quantities of blood and drawing them from parts of tlie body where a 



127 

congestion may have existed. I spoke in general also concerning congestion, 
and tlie way we treat it. I also brought ont certain landmarks concerning 
the thorax and certain points in examination of the parts of the thorax. I 
wish to continue that subject to-day. 

I. Landmarks of the Thorax. — ^ After Holden: The interval below 
the clavicle is the sub- clavicular space between it and the upper margin of 
the pectoralis major and the deltoid externally, and is important as a guide 
to us to find the coracoid process. By drawing the arm up and backward in 
this way, thus tensing those muscles, we can feel the sub- clavicular space, 
and at the outer part, near the shoulder, we can find the inner side of the 
coracoid process. Also that space corresponds in direction to the direction 
of the axillary artery, we can feel it pulsing in there, and can compress it 
against the second rib. The internal mammary artery runs perpendicular to 
the cartilages of the ribs, and about half an inch external to the margin of the 
sternum. Its perforating branch at the second intercostal space, is the chief 
one. It becomes important for us as Osteopaths in examination of the heart 
to know just what its topography upon the chest wall would be. The follow- 
ing description of the outline of the heart on the chest wall is given: 

That the base corresponds to a horizontal line drawn from the third costal 
cartilages, their upper border, extended a half inch to the right and inch to 
the left; that the apex is found by measuring one inch internal and two inches 
below the nipple, this point being between the fifth and sixth ribs; that the 
lower margin may be outlined by drawing a line from this point 3f the apex, 
bulging slightly downward to the end of the sternum, the xiphoid cartilage 
excepted, that line extended as far as the right edge of the sternum; that the 
right border would therefore be indicated by a line joining point at the right 
inferior extremitj^ of the sternum with a point on a level with the cartilages 
of the third rib, extended half an inch to the right, while on the left the bor- 
der would be indicated by a line drawn from the left extremity of this line at 
the base, an inch and a half from the sternum on the level with the third 
costal cartilage down to the point which indicates the apex. In that waj'j^ou 
would get the outline of the heart ux)on the chest wall. It is said that a needle 
passed into the third, fourth and fifth intercostal spaces on the right side just 
next to the sternum, would perforate the lung, pericardium, and the right 
auricle. A needle passed into the second interspace would perforate the 
aorta at its greatest bulge, also the part of the pericardium which is reflected 
over the first part of the aorta. And that a needle perforating the first inter- 
costal space on the right of the sternum would enter the superior vena cava. 

This rule is given for finding the extent, or outlining in general the dull- 
sounding space in the precardial region made by the presence of the heart; 
take a point midway between the nix)ple and the sternum, a point midway for 
your center, and describe about that a circle with a diameter of two inches. 



128 

and that will include practically all of this dull- sounding region over the 
heart. 

The apex of the heart, as you know, beats between the fifth and sixth 
ribs. Its impulse is readilj^ felt there, but that is not an invariable place to 
find it. You can change the position of the heart by changing your jjosition. 
You may cause the heart to deviate from its usual locus by turning from side 
to side. In deep inspiration the heart may descend somewhat, so that when 
you have taken a very deep breath you may feel the beating of the heart over 
the pit of the stomach. That is, you can get the impulse at that place. 

As to the valves of the heart and their location externally: The aortic 
valves are located behind the third intercostal space close to the left border 
of the sternum; the pulmonary valves at the junction of the third costal 
cartilage with the sternum, on the left; the tricuspid valves are on a level 
with the cartilage of the fourth rib just behind the middle of the sternum, 
and the mitral valves are at the third intercostal space, about an inch to the 
left of the sternum. Since the valves are close together they are readily cov- 
ered by the tip of the stethoscope, or what is better for our use, by the ear. 
And since they are covered by a small amount of lung tissue you can hear 
the heart better by having the patient hold the breath while you listen to the 
beating of the heart. For the reason that these valves are so close together 
it is better in trying to distinguish the sound from each, to go out a little way 
in the direction of the current from the '^alve. Thus, in sounding the aortic 
valves, you would go to the second intercostal space, just at the right edge of 
the sternum. For sounding the pulmonary valves, you would go to second 
intercostal space at the left edge of the sternum. To sound the tricuspids 
you would take the point at the end of the sternum just behind the middle, 
and to observe the sound of the mitral valves you would listen at the apex of 
the heart. That is according to the direction that the blood takes. 

For finding the outline of the lungs upon the chest wall: You know that 
they rise above the clavicle an inch and a half, or in some cases two inches; 
that there is but very little lung tissue behind the first part of the sternum; 
that from the sternal articulation down to about the second rib, the anterior 
edges of the lungs converge. From the second to the fourth they are close to- 
gether in the median line, quite close, and also about parallel. Below this 
point their course on the different sides is different. On the right side it fol- 
lows down along the course of the sixth costal cartilage. On the left it is 
notched for the heart, descending back of the heart. On the left side it de- 
scends as far as the lower border of the fourth rib, which it follows. It 
reaches a line drawn perpendicularly from the nipple, at the loMor edgi^ c^f 
the sixth lib. In the axillary region on each side it is found at tlie lower 
edge of the eighth rib, and behind, extends as far down as the tenth rib. Of 
course in the deep inspiration it descends still lower. 



129 

II. ExAMiis^ATiON OF THE THORAX. (Continued.) — I began to take up 
this examination at the last meeting. I wish first, to give you some points 
concerning the divisions of the thorax, which, while they are not of so much 
use to us as Osteopaths, as we do not divide the thorax into such spaces in 
our practical work, I thought it best to describe them to you for the sake of 
your understanding them when you come across them in your reading, so that 
you will know what is meant by the mammary region, the scapular region, etc. 
This division is the one adopted by Loomis. He divides the chest first into 
three general regions, the anterior, lateral, and posterior. The area on the 
anterior aspect is again divided : The supra-clavicular portion is that, in gen- 
eral, just above the clavicle. The clavicular portion is that corresponding to 
the inner three-fifths of the clavicle, and is bounded by that bone. The in- 
fraclavicular space extends from the lower border of the third rib ; internally 
it is bounded by the edge of the sternum, and externally by a perpendicular 
line dropped from the junction of the middle and outer third of the clavicle. 
Next below comes the mammary region, extending from the lower bolder of 
the third rib to the lower border of the sixth rib, extending inward as far as 
the edge of the sternum, and outward as far as the last described. Next, as 
for the sternal region: There is the suprasternal region, which he describes as 
the region just above the sternum. The superior sternal region is that portion 
behind as much of the sternum as lies above the inferior border of the third 
rib and the inferior sternal region, that behind the rest of the sternum. 

On the posterior aspect we have three regions : The supra-scapular, and 
the scapular, corresponding to the space from the second to the seventh ribs 
inclusive, and corresponding recpectively to the supra-spinatus and infra-spin- 
atus fossae of the scapula extending inward m this region as far as the inner 
or spinal edge of the scapula, and extending outward as far as the axillary 
region. The infra-scapular region extends from the lower angle of the scapula 
and the seventh dorsal vertebra down to the lower margin of the twelfth rib ; 
extending internally in this case to the spines of the vertebra and externally to 
the inferior axillary region. There is also an inter-scapular region, one on 
each side, corresponding to the space between he second and sixth ribs, and 
between the inner or spinal edge of the scapula and the spines of the dorsal 
vertebrae. Speaking, by the way, of listening io the sound of the aorta, it is 
also heard in the posterior region of the back from the third down to the 
ninth dorsal vertebra. 

Laterally we have the axillary space, bounded above by the axilla and be- 
low by a line projected from the mammarv space, that is, from the inferior 
border of the third rib. Then we have the infra-axillary space, extending 
from the axillary space above down to the lower margin of the 12th rib ; 
bounded in front by the infra-mammary region and posteriorly by the infra- 
scapular region. 



130 

You koow already as far as practical for our work the contents of these 
different regions, especially when studied in conjunction with the points I 
have already given you in these landmarks. As I said, I give these general re- 
gions to you, not to detail the parts found in them, but so that you will under- 
stand, when an author speaks of thes':! general regions, what he is speaking of. 
You are of course aware that in making a physical diagnosis, of which our 
method largely consists, and which our medical friends seem to leave out in a 
great many instances, we use auscultation, inspection, percussion, palpitation 
and mensuration. In our examination we want to hear and see all that we can 
that is going on about the human body, especially in tne way of examining 
and making out things which have caused a departure from the normal. I 
mentioned certain points at the last lecture in relation to the chest. There is 
another point that I wish to speak of which is important in our practice, and 
that is the movement of the chest as to whether the two sides correspond, 
whether one side is restricted in movement as in the case of pneumonia or 
whether the inferior ribs are drawn in as in some cases of asthma, where I 
have seen them drawn in extensively. Also note whether or not the action of 
the opposite side is normal or increased to compensate for lack of normal on 
the other side. It is taken as a very good sign of tuberculosis if there is a 
depression in the infra-clavicular region. A great deal more might be said 
about these different methods of physical diagnosis, but it is hardly the place 
here to go into them extensively. In considering palpitation, that is the ex- 
amination on the surface with the hand, I brought up certain points last time. 
We should not only touch both sides of the thorax in making the examinaliou, 
but we should touch with equal force and touch in the same place each time, 
and you need not lay your hand on heavily, lightly is sufficient. Auscultation 
and percussion are by far the most important methods in dealing with the 
chest, especially since it contains the heart and lungs, and to get a good idea 
how the heart and lungs are behaving we must listen to them directly and 
also listen to them by percussing the region in which they lie. The authors, 
of course, have different methods of bringing out these points. I have been 
reading Loomis and he seems to have some very good points. Of course they 
all make this statement, that percussion is either immediate or mediate. Im- 
mediate percussion or direct tapping upon the part is the old method and is 
very little used nowadays. The mediate style is the one used most, in which 
you use a little rubber tipped hammer of some sort as you percuss, and what 
is known as a pleximeter placed between the hammer and the part sounded. 
That is very rarely used. It is stated by some authors lliat we have as good 
instruments as necessary, the middle or index finger of the left hand being the 
pleximeter and the fingers of the right hand being the hammer. There are 
certain simple rules that we may adopt in using this method of physical diag- 
nosis. First, it will be of little value to voii to find a difference in sound uu- 



131 

less both sides of the chest or of the part of the body which is bein^ examined 
are similarly disposed so that one is not in a higher plane than the other. You 
must be extremely careful of the position of the patient. Then, also, you 
should have the parts slightly tensed. For instance in examining the chest 
the arms should drop downward and the head be thrown back. If you are 
percussing the axillary region have the arms lifted. If you are percussing the 
back have the patient stoop over slightly so as to bring tension on the part per- 
cussed. That should be done evenly ; a patient should not have one arm down 
and the other over the head. The conditions on each side should be similar. 
It is well to make the examination directly upon the skin, or if that is not 
practicable make it upon some thin, soft cloth spread over the chest, of such a 
nature that it will not interfere with the sound. You should, of course, per- 
cuss equally on each side, and m case of the lungs you should take it at the 
same stage of respiration, that is, you should not tap on one side while the pa- 
tient is inhaling and on the other side while the patient is exhaling. You 
should have an equal pressure with the pleximeter finger and an equal forcible- 
ness of the striking hand, because you can make the sound different by strik- 
ing harder on one side or by holding the hand more loosely against the surface 
you are examining. The best percussing motion comes from the wrist and 
not from the whoJe arm, and in general tap lightly for an examination of the 
superficial parts and more forcibly for parts more deeply located. 

In the practice of auscultation the same general rules will apply ; you have 
the immediate in which you apply the ear directly to the part, or you have the 
mediate in which you use some instrument as a stethoscope. The authors dif- 
fer a great deal as to whether a stethoscope should be used. Loomis is par- 
ticular that it should be used m examining the heart but does not care much 
for it in examining the lungs. Raue, whom I sometimes read, says he prefers 
in all cause the use of the ear alone unless considerations of cleansiness make it 
convenient for the use of the stethoscope. If you are axamining the chest and 
it is covered see that the covering is a thin soft cloth, a towel will usually do, 
something that will not interfere with the sound. See that your patient is in 
a proper condition with both parts disposed alike, and give your full attention 
to the sound itself. The ear should be evenly applied in each case alike, not 
forceably but firmly. You should listen to the corresponding parts, and in 
touching you should touch over the corresponding parts, for instance it would 
not do to tap over a rib on one side and over the interspace on the other. You 
must examine the corresponding parts, no matter how you do it, and then, of 
course, especially in respiration, it is better to examine under conditions as 
nearly normal as possible, have the patient breathing quietly and in a natural 
way. 

I mention these things to you more for the sake of a hint of what there is 
in this subject and what there is for you to study, since it is quite a complex 



132 

subject to go in detail over the different sounds that you will hear, and to do so 
would probably confuse you more than elucidate the subject. Also it is very 
difficult to show these things without clinic material, and you can only learn 
them by practice. You should become perfectly famihar with the sound of 
the normal parts both on auscultation and percussion, and then you will note 
any departure from the normal when you come to make examinations, and also 
to distinguish the different abnormal sounds one from another. However, this 
is quite an imporant subject. I would advise you to become familiar with the 
instrument that you are going to use. I do not think it is generally recom- 
mended that the Osteopath should use a stethoscope. That is a matter of taste. 
The vvay is to get familiar with the sounds by the ear if you are going to use 
the ear, or familiar with a certain stethescope, as the sounds vary with different 
instruments. 

III. How TO Examine for Displaced Ribs. I examined the different 
parts of the thorax at the last time. In the first place, I need hardly to remind 
you that in variations in the spine, any abnormal curve in the spine, either 
curvature or departure from the normal curves, will tend to 
alter the normal position of the ribs. So that in examining the 
spine if you find that the parts are not in normal position, of course 
you will at once look for dislocations in the ribs corresponding with the affected 
part in the spine, to see whether or not the affection has extended that far. 
You may find a general alternation in the shape of the chest, as for instance the 
flattening in the paralytic chest in its anter-posterior diameter ; or flattening in 
lateral in rachitis, or bulging or barrel shaped chest in asthma or emphysema. 
Of course you will then see at once that there is a change not only m the thorax 
in general but in the parts necessarily, and that you will probably find that the 
ribs are misplaced. To examine and replace subluxated or displaced ribs is one 
of the most important parts of our practice, not only because it occurs so fre- 
quently but because it is very troublesome. They often cause serious trouble 
and are hard to locate in some instances, they will require your very careful at- 
tention. We might explain why it is that ribs when displaced cause so much 
trouble. I think the theory already advanced will explain that as far as it goes, 
that is, parts out of the normal, whether they be ribs or vertebnv, will briuiz 
pressure in some cases upon structures such as nerves and blood vessels : in 
other cases they would drag ligaments across important structures. In other 
cases they may result in contractures and that will be followed by other results 
already noted. So in examining a spine nnd the chest particularly you should 
examine each rib. I have already given you the rules for counting the ribs, 
and having found where each rib is you should examine each rib in parti'nilar. 
It is said where a rib is displaced you will very likely tind tender points alono- 
its course. Dr. McConnell says that usually there is a tender point at tho^^pi^o 
where it IS displaced, another about the middle region and another at tho an- 



133 

terior end. You will also find cases where they are sore almost all the way 
along, especially the anterior half. 

The ribs may be pressed together behind and separated in front. In 
general you will look for the soreness over the rib and over the part of the 
interspace which is narrowed. I have found that to be so in my experience 
at least. The displaced rib may be separated from one rib, which naturally 
causes it to be approximated to some other rib, and you will judge which it 
is by finding the widening above and the narrowing below, for any one rib or 
any group of ribs. Then your rib may be changed, not being slipped up or 
down, but may be twisted so that you will find that one edge is more promi- 
nent, and in this case it is very common to find the under edge the most 
prominent. The best method that I have found to examine whether the ribs 
are separated is to take the tips of the fingers and follow down the course of 
the intercostal spaces. You can then learn, knowing the normal, whether or 
not these parts are too much separated or too close together; you will also 
note whether or not they are not twisted. Sometimes the cartilages will be 
distorted, and in that case you will find an irregularity and a tenderness 
along them. They may be twisted or may have been torn and grown to- 
gether. I have seen several cases in which the cartilage had been broken 
away from the tenth rib and the person had three floaters on each side in- 
stead of two. It is said to be a fact that there is a little weaker attachment 
of the cartilages to the ends of the ribs in the case of the tenth than in the 
case of the other ribs. In examining the ribs of the patient what I have said 
will apply to all of the ribs, but of course we must apply our examination to 
all parts of the thorax, anterior and posterior. But in examining the first 
and second ribs j^ou will find that something more of a consideration. The 
first and second ribs, on account of their attachment to the scaleni mus- 
cles are usually displaced upward because the tendency of these muscles when 
contracted is to draw the ribs upward. In the first place, how would you 
tell whether or not this first rib is up? To find it you feel down about the 
middle point of the clavicle, press down and back and you will immediately 
come to the first rib. You must first know that the clavicle itself is in posi- 
tion. If its acromial and clavicular are both in situ then you can judge from 
the relative position of the first rib whether it is up or down. Of course the 
more it is slipped up, the more it tends to come on the level with the upper 
ridge of the clavicle, or if it is down it will widen the space between them. 
That is one of the best ways of determining by examination whether it be up I 
or dow^n. The second rib is somewhat more difficult to get at. You can feel 
it, as I noted, in the outer portion of this infra- clavicular space by drawing 
the arm outw^ard and down tensing the muscle. You can also examine it by 
finding the junction of the first and second parts of the sternum; follow the 
cartilage out, you can feel it as far as the clavicle. Note whether the points 



134 

are sore at the places where you can reach the rib, and by following further 
there will be a difference in the intercostal space, and you can tell whether 
the second rib is up or down, but it will require practice and I will promise 
you that the first and second ribs are very hard to deal with. Just as the 
first two ribs are usually up, the last two by some strange compensation of 
nature, go down. As the man said, ''There is compensation in everything; 
snow comes down in winter and ice goes up in summer. ' ' The reason why 
these last two ribs go down, especially the last one, is that the quadratus 
lumborum muscle is attached to it, and it seems to be the nature of the 
eleventh to follow the twelfth in its course downward, I do not know just why, 
unless it is because it is not attached by a cartilage to the others above, and 
is free to follow the other. The position of these ribs is very readily ascer- 
tained even in a fleshy person. It will take considerable dexterity of touch 
to accustom you to find them, but by patience you can do it. Of course any 
of these ribs may not only be slipped up or down, but one may overlap the 
other. I saw a case the other day in which the tenth was overlapping the 
eleventh quite prominently. Then, you may find that these last two floating 
ribs instead of being down maybe up, and the twelfth may be pushed up 
under the eleventh. In that case they often cause trouble, but they may 
sometimes be down without any trouble at all, in which case it will not be 
necessary for you to bother with them. 

I wish to tell you how to set this clavicle. I noted it in the examination 
the last time. Suppose, in the first place, it is down. It may be down at 
either end. I believe the commonest place for it to be down is at the outer 
end, because of the attachment of the deltoid and of the pectoralis major to it 
at the outer end. The way the "Old Doctor" told me to treat that is to get 
the fingers against the anterior edge of the clavicle near the sternal end, draw 
the arm then inward, across the chest thus relaxing the ligaments and the 
muscles. Then push outward upon the first point that I noted, the anterior 
edge of the clavicle, push outward, and draw the arm up backward. Thus 
having relaxed the ligaments and muscles, 5 our push will serve, on account 
of the peculiar shape of the clavicle, to push it on to its proper articulation. 
In case it is slipped up at the acromial articulation, that sometimes happens 
and causes a catching of the fibers of the deltoid, or it impinges on the fibers 
of the brachial plexus, the best way is to raise the arm to relax all muscular 
tension, since it is bound to the shoulder here by the deltoid parth', and 
some of these smaller muscles; relax them in that way, and then you can got 
your fingers in behind the part that is slipped up, and it does not make much 
difference which way you throw the arm. Dr. Harry says when a joint is 
out almost any way you turn it, it will want to pop back where it belongs, 
which of course is true, that is the tendency toward the normal. In case it is 
down at the sternal end, which you find with a fair degree of freqiuMu*> , oiu* 



135 

of the best ways is to thrust the thumb of one hand under in behind the 
sternal end of the clavicle, thrust it in deeply, and then relax the muscles by 
drawing the arm up and inward. Then by drawing the arm over, down and 
out and thus tensing the muscles, it brings a leverage upon that end of the 
clavicle, and will force it up. Or you do practically the same thing by bring- 
ing the arm up and around and making a twist in such a way as to tense the 
muscles. In other words, this is just a system of animal mechanics whereby 
you study out the shape of the bones, their attachments and ligaments, and 
attachment of the muscles, and just how to use these ligaments, bones and 
muscles, as levers and pulleys, so as to work them back into place. N^ow, if 
the clavicle is up, the point of course would be to relax again and simply 
force it down from above by working with the thumb in behind it. Another 
good way to free up the space between the clavicle and the first rib is to thrusc^ 
the fingers in behind the clavicle where it is always tender, and draw the arm 
up over the face and then on out, thus getting a very good leverage. 



LECTUEE XXI. 

At the last lecture I took up certain landmarks of the thorax, showing 
you, among other things, what was the outline upon the chest wall of the 
heart, where to note its valves, and where to listen to the sounds produced 
by their action; that the point at which you should listen varies from the 
position of the valve in the direction of the current of blood. Also I noted 
the topography of the lung upon the chest wall. Then I took up certain 
points in the examination of the thorax, showing you how it was divided into 
the different regions; then spoke concerning auscultation, palpation, mensura- 
tion, percussion, etc., the different methods that we use. Then I brought up 
the point of how to examine for displaced ribs. To-day I wish to take up 
more particularly the contents of the thorax, viz., the heart and lungs. They 
are, of course, important to the Osteopath, aud since they have so much to do 
with life, they must be carefully looked after. I think that the Osteopath has 
more success than other forms of healing with troubles in the heart and lungs. 
A great many troubles of the heart are not organic, and when not organic the 
opportunities for Osteopathic work are much better than when organic. 

I. Some Centers and Nerve Connections for the Heart and Lungs: 
There are certain facts that we come across in our osteopathic work which lead 
us to reason about nerve action. In the first place, displaced ribs will very 
readily affect the heart. Sympathetic troubles, such as crying and the like, 
are caused by contractures along the left side of the back between the shoul- 
ders, or by displacements in that region ; displacements of the third, fourth and 
fifth ribs particularly. From the fact that we can reach the heart through the 
superior cervical ganglion and in the upper dorsal region on the left side, and 



136 

from the fact that there are certain centers given, as that in the medulla, and 
for the rhythm of the heart in the upper dorsal repjion, from the second to the 
fourth, we naturally wish to know what is the nerve connection, and why it is 
that working there we can get such an important effect upon the heart. That 
we do get these effects, of course our practice shows, it is simply a question of 
fitting theories to these facts. In the first place, we sometimes work along 
the splanchnics, and thus get an effect upon the centers, which I explained at 
length in the lecture the other day. Then there is our work in the upper dor- 
sal region. Those are the two places, except the neck, where we get the most 
important effects. Now, as to this nerve connection between the heart and the 
spine, Jacobson brings out the connection here very admirably, in relation to 
the infra-mammary pains. He shows how the viscera are connected through 
the sympathetics, the great splanchnic particularly, connected with the spine 
as high as the fourth, fifth and sixth spinal nerves. We have learned that the 
great splanchnic may arise as high as the third also. These spinal nerves send 
certain sympathetic branches to the aorta, from the fourth, fifth and sixth sym- 
pathetic ganglia, branches are given off which form a plexus about the aorta. 
This plexus over the aorta gives branches to the cardiac plexus about the heart. 
Further, there are branches given off from the fourth, fifth and sixth, cutane- 
ous branches, descending over the ribs and supplying parts along the sixth, sev- 
enth and eighth ribs. Hence you have a direct connection between the pain 
which you feel by means of these cutaneous nerves of the sixth, seventh and 
eighth interspace which run in their distribution beneath the breast, in the 
infra-mammarv region, a connection with the spinal nerves and thus with the 
fourth, fifth and sixth spinal nerves, and through them oat to the sympathetic 
plexuses about the aorta and the heart. Thus, you have an indirect connection 
between the viscera on the one hand, and the heart's action en the other. You 
may have pains in the infra-mammary region caused by diseases of the heart. 
Hilton, himself, also states something concerning the sympathetic pains which 
we may feel on the surface of the body. That pains from diseased viscera, the 
liver or intestines, for instance, are often reflected to the region between the 
shoulders or at the inferior angles of the scapula. You can readily see how 
this connection takes place, between the sympathetics from the great splanch- 
nics and those of these fourth, fifth and sixth, and directed to the region of the 
scapulae and the region between them and about their angles. Tluis we see how 
we may have pain in a distant part of the body when a certain terminal is 
affected. I have, myself, noticed in certain cases of trouble with the liver, 
where the liver was rather tender, that I could get a pain under the scapula, 
especially on the left side. 

Taking into consideration the connection between the heart and this upper 
dorsal region, the fourth, fifth and sixth, you can see how the Osteopath, by 
working there, where he does very frequently to affect the heart, can get an 



T 



137 



effect upon the heart, and thus upon the general circulation. I think I instanced 
the point that by working along the splanchnics and by working along the 
upper dorsal region, I could get important effects in quieting the heart. I have 
sometimes quieted the heart as much as from ten to twenty beats per minute, 
when it was running high by work in this region. Thus you will see that 
work here upon the heart is directly upon nerve action, but we must not omit 
to notice the fact that by raising the ribs we get a mechanical effect, if those 
ribs were so lowered as to narrow the cavity in which the heart acts. Any les- 
lesing of that cavity has a tendency to interfere with the heart's beat, so that 
by mechanically enlarging the cavity we also get an effect upon the heart. It 
is probable also that the raising of the ribs frees pressure upon nerve connec- 
tions along the spine. 

Further, as to connections in the upper dorsal region between the nerves 
there and the heart, Quain says, that accelerator fibers of the heart derived 
from the upper four or five dorsal nerves, but chiefly from the second and third, 
are sometimes found. The spinal fibers begin in the middle and lower cervical, 
perhaps also the first thoracic ganglion. That is, these fibers really come from 
the sympathetics, the change of fibers occurring in the ganglion mentioned. He 
says further, that vaso-constrictor fibers of pulmonary vessels have been found 
in the dog from the second to the seventh spinal nerves, and that they connect 
in the stellate ganglion. In the dog and cat it is said that the lower cervical 
and upper thoracic ganglia are connected to form what is called the stellate 
ganglion. While it has not been demonstrated in man that these fibers arise 
from the second to the seventh, these vasu-contrictors foi the pulmonary ves- 
sels, it looks probable that there are some such fibers existing, since that is the 
identical center upon which we work to affect the lungs, the second to the sev- 
enth dorsal. Howell's Text Book states that stimulation of the vagus in the neck 
constricts the pulmonary vessels, while stimulation of the sympathetics of the 
neck will dilate the pulmonary vessels; also that there is noted a reflex con- 
traction of the pulmonary vessels by stimulation of some other nerve, as for 
instance, the sciatic, intercostal nerves, abdominal pneumogastric, or ab- 
dominal sympathetics. This will call to your mind instantly what I have 
said concerning regulative processes, in our work upon different parts of the 
body. I mentioned that particularly in relation to the splanchnics; you see 
the reflex effect gained by stimulation of these nerves in distant parts of the 
body, and its effects upon the lungs. You see how general that work may 
become. It is an interesting fact to note what Eobinson says concerning the 
heart and the aorta, which are directly connected with the circulatory system. 
He says that they have been noted at times to have periods of violent rapid 
beating, and that the heart itself and the aorta appears to be dilated and to be 
working very forcibly; that feeling of the pulse in other parts of the body 
would not indicate that the effect was general. Eobinson says that this has 



138 

been little made of in books, in fact, lie does not know tbat it is mentioned 
except something about the aorta, and explains it by influence of one kind or 
another which may effect the various sympathetic centers. And in case of 
the aorta he says he has seen, in case of a thin woman, it beating violently 
and simulating in every respect an aneurism. He explains it by saying that 
the centers in the substance or in the immediate neighborhood of the aorta, 
are in some way affected, though the effect may, of course, be dependent upon 
general conditions. 

II. Examination of the Heart. — First, some general points as to the 
heart. The ^^Old Doctor'' explains some of his recent illness by a stoppage 
of the aorta at the point where it perforates the diaphragm. He says that 
frequently some injury there may cause a constriction, especially if the injury 
is of such a kind as to allow a relaxation of the usual vault of the diaphragm, 
causing a constriction about the point where the aorta passes through, and 
thus constricting and restricting the blood flow. Thus, he says, the heart 
goes to work pounding to force the blood through, and you have palpitation 
of the heart. That is similar to effects we have in other parts of the body, 
where a thickening of parts about an important structure would lead to 
troubles which were of peculiar significance to the Osteopath. So the "Old 
Doctor" wears a belt. He says that compresses the lower part of the thorax, 
allows the aorta to bulge upward. 

Second, as to your examination. You must take into consideration that 
the heart, being so closely connected with sympathetic life in every part of 
the body, is affected by general sympathetic disturbances. You may have 
trouble almost anywhere; in the neck or with the genital organs; and of 
course you get an important effect upon the heart and circulation by dilation 
of the rectal sphincters. Such a slight cause as a dropping of the acromial 
end of the clavicle, or either end of the clavicle, for that matter, shutting 
down upon the circulation through the subclavian artery and vein, generally 
the vein, has caused angina pectoris. I knew of a very bad case where the 
woman was ready to die of heart trouble and looked about as bad as a person 
could look. She was cured by the ''Old Doctor" by setting the clavicle. It 
was a typical case, with the radiating pains over the chest and all the accom- 
panying symptoms. That lady is one of our graduates now and enjoying a 
lucrative practice. x\lso the same kind of a slip may cause a periodic em- 
ptying of the innominate vein, and thus lead to a loss of a beat of the heart 
occasionally, so that the heart will be beating irregularly. So please consider 
that in looking for trouble with the heart, you will need to examine not only 
the region of the thorax, but everything that might affect the vessels coming 
fiom it. Do not forget the clavicle or the first and second ribs. The tirst 
and second ribs are apt to cause troubles of tlu^ heart. Tlie reason seems to 
be that since they are usually displaced upward, they bring pressure upon 



139 

some of the blood vessels or interfere at the spine with some of the important 
nerves which I mentioned in the previous part of my lecture. I do not know 
but that it should be as much a matter of pride with us to observe a profes- 
sional demeanor in our calling upon a patient, as it is with our medical 
friends. I have gone with a student to see a patient where there was trouble 
.with the heart — I remember one case particularly, a case of asthma. I went 
in and felt the pulse the first thing, as I usually do; the heart was beating at 
the rate of 120 per minute, and the student had not noticed it. So it will not 
be a bad idea to always note the pulse. It is, of course, an important clue 
to the state of the circulation. It will tell you whether or not the heart is in- 
termitting; whether or not the heart is beating too strongly or too weakly; 
\v hether or not the pulse is normal in every respect. The strength of the beat 
YOU can tell, then, and the frequency and the regularity. So I always first 
lake the pulse, which is usually found best at the left wrist at the radical 
artery; you all know how to find it. Also note the chest, the shape of it. In 
enlargement of the heart there may be a bulging in the precordial region. Or 
narrowing of the chest may interfere with the heart. Do not forget inspection 
of the chest in examination for troubles of the heart. IS^ote also by inspection 
and by palpation whether the apex beat is normal, occurring at the inter- 
space between the fifth and sixth ribs. You can, by knowing how it beats 
normally, tell when it has departed from the normal, whether it beat too 
strongly or weakly. Or it may be displaced to one side or the other by 
troubles of the other viscera, the lungs, for instance. ^S'otice by inspection 
and palpation where the apex beat occurs. By palpation, not only at the 
apex but over the region of the heart, preferably with the patient sitting up, 
you can note the three points that you want, that is, regularity, frequency 
and strength of the beat. It is not a bad point in examining for enlargement 
or encroachment of other solid viscera upon the heart, to use percussion. It 
is as well to percuss next to the skin, or through some soft thin cloth. The 
best way to make a pleximeter of your left hand is by laying not the whole 
palm of your hand, but just the middle finger upon the surface to be per- 
cussed, and then striking it with the tips of the fingers of the right brought in 
line, or by the first or index finger. Of course when you come to the heart 
you note its flat sound. I noted to you the Dther day how to find that region, 
a circle drawn two inches about a point midway between the nipple and the 
end of the sternum. 

Dr. Sheehan called my attention to a point the other day: In making 
percussion over the parts of the lungs which are most liable to be affected in 
tuberculosis, make it light because there is some danger of starting a fresh 
hemorrhage if you use forcible percussion. Light percussion is as effective 
as is forcible. Of course this flat sound of the heart may vary, as for in- 
stance in emphysema it may become resonant. Or it may be increased by 



140 

some effusion in the pericardium, or some effusion in the pleura or some en- 
largement of the stomach upward, or by solidification of the lung, anything 
that will make a larger area of the flat sound in the region of the heart. By 
studying these things they will be an important aid to your diagnosis. 

We also practice auscultation upon the heart, by placing the ear over the 
region of the heart. This is the best method of examining the heart. You 
will want to note the sounds of the heart particularly, and for doing that you 
would have to know the sounds for the various valves of the heart. Of 
course there are various murmurs, regurgitant, restrictive, etc. There are 
murmurs that occur in several conditions of the heart. Sometimes there is a 
venous murmur, as in the jugular vein. It is said that by holding that vein, 
and compressing it for a few minutes you can stop that hum. To differentiate 
between it and the heart murmur, particularly that caused by percussion of 
the heart against the pericardium when it has been thickened by some in- 
flammatory process, is difficult. It is also difficult to differentiate from other 
murmurs in the heart, and the only way is to find that this sound follows, 
while the other accompanies the heart beat. 

A great deal, I am aware, might be said about physical examination of 
the heart, about the analysis of these sounds, but should I go into that sub- 
ject extensively it would make a set of lectures as large as that I am deliver- 
ing in general. It is only by study along those lines and by practice that 
you will learn both the normal and abnormal. But I brought them up for 
your notice, and leave them for the more important part, the osteopathic 
practice, which I shall consider here. 

III. Examination of the Lungs. — We adopt the same methods for 
percussing the different regions of the chest. For instance, if you were 
sounding here over the clavicle, you get a dull sound; while in the space just 
below we should get a resonant sound; over the larynx, especially with the 
mouth open, you get a higher sound, called tympanitic. You must become 
accustomed to these normal sounds. Anything which will cause a solidifica- 
tion of the lungs about the tubes or thickening of the tubes themselves, in 
fact, an accumulation, or any growth which aids transmission of sounds will 
change the character of these sounds, making them more resonant, higher; 
while the effusion of any liquid, such as blood in hemorrhage, or in the case 
of pleurisy the effusion of lymph or serum, or the accumulation of pus will 
also interfere with the sound and make it more dull. There is a tympanitic 
sound found in the lung when there is a large cavity not communicating Mitli 
a brochus; when the cavity communicates with a bronchus we get what is 
called the ''cracked-pot sound." Our chief methods of examining the lungs 
are by percussion and auscultation; these are two of the best methods. 1 am 
aware that this subject under my treatment is a vtM'v dull subject \o yon. 
However, it will be a very important one and will merit further study. If 1 



141 

liad the time and ability to go into the subject more fully I would spend more 
time upon it. As it is I can best call your attention to the more important 
osteopathic points in relation to the lungs by taking up certain of the troubles 
which affect the lung. As for instance in asthma you may have trouble any- 
where along the back from the second to the seventh ribs, especially on the 
right side. It is said that the sixth rib upon either side may be displaced 
and cause this trouble, or if there is any pain upon taking a deep breath 
probably the fifth rib is in terf erred with. There also may be an interfer- 
ence with the phrenic and pneumogastric nerves in the neck, some stoppage 
of the nerve force in those nerves will cause asthma. In case of bronchitis it 
is said the first, second and third ribs are at fault, especially in case of the 
first, or the clavicle may be displaced downward, or either of the nerves I 
have mentioned in the neck may be impinged upon. In congested lungs you 
will find the best method is to work along the upper dorsal region, raising all 
the ribs. I have at that point very quickly relieved the congestion in the 
lungs, simply raising all the upper ribs; working between the shoulders. 

Hay-fever is usually found in lesions from the third cervical down to the 
fifth dorsal; you may have trouble either in the neck or of the upper ribs, or 
your clavicle may be displaced, or those nerves I have mentioned may be im- 
pinged upon. Of course in working upon any of these troubles where there 
is probability of complication with general troubles you must take that into 
consideration. In relation to the lungs Dr. Still has been speaking recently 
of the formation of gases upon the lungs, and that in fever the gases are 
formed but are not transformed into perspiration, and therefore the natural 
cooling process does not go on and you have fever resulting. In fever his 
work is largely upon the lungs, he says, to stimalate them to action to cause 
the proper combination of gases and the resulting perspiration. In the same 
way he explained the other night the cause of the abnormal amount of secre- 
tion of sweat in cases of cholera. 

As to how to raise the ribs, I brought out the points of examination for 
the ribs the last time. Dr. Charlie Still has the patient take a deep breath and 
then by placing the fingers of one hand upon the spinal end of the rib and of 
the other on the sternal end of the rib, he pushes the rib either up or down. 
That is one method which he uses. Dr. McConnell frequently works with his 
knee in the back, as do also the other operators, and in that case the idea is to 
get the point of the knee at the angle of the rib which is displaced, and then 
you can have one hand free to reach over the shoulder of the patient and get at 
the sternal end of the rib^ while with the other hand you bring the arm up, 
thus tensing the pectoral muscles and the latissimus dorsi. which are attached 
to the ribs ; drawing the arm toward the head, back and around in such a way 
as to draw the ribs up. When you have gotten them up to their highest point, 
then relax the arm and let it drop, still holding the knee and the hand agains 



142 

the ends of the rib. Dr. McConnell also sometimes works by getting the knee 
against the back and by putting both hands against the front part of the rib, 
especially when you want to raise the front part. It does not make very much 
difference, anyway you can get tension ot the pectoral muscles and the latissi- 
mus dorsi, getting a leverage on the ribs, and having a fixed point against the 
ribs behind ; no matter how you do that you will be able to move the rib. 
There is another way which is frequently used, and that is, the patient being 
upon the table upon his side, you can get the knee in the back in the same way, 
you can get one hand upon the arm of the patient, the other upon the anterior 
end of the rib and draw the arm up and back in the same way ; thus you can 
raise any one rib or all of the ribs. Also, as I showed you the other day in treat- 
ment of the liver, you can reach across and beneath the patient, getting your 
fingers against the angles of the ribs and using the tension of the pectoral mus- 
cles in the same way to draw the ribs up. You will find all of those methods 
quite simple, and the reason, perhaps, that there are so many different ways de- 
vised to raise the ribs is the fact that you have to work in so many different 
positions, sometimes one will be more convenient, sometimes the other. If 
you are treating a patient sitting on the bed, or on the table you will have to 
adopt the method that will be the most convenient. This will serve to raise 
the different ribs. But when you come to the first and second ribs it is a 
different matter. These displacements are usually upward owing to the 
scaleni muscles being attached to them. Hence to treat them, we make use 
of these muscles. When these ribs are up, one good way is to bring the head 
of the patient toward the side of the rib affected, then pressing the fingers 
down about the middle of the clavicle, in that way you come to the first rib. 
You can get firm pressure there and can bring tension upon it by pushing the 
head in the opposite direction, thus stretching the scaleni muscles, which are 
on a strain and which are holding the rib up. Thus we get those muscles 
stretched and by working the head around and bringing pressure still upon 
the first rib, you can press it downward. That applies to both the first and 
second ribs. Of course also in case of the second rib you can get the pres- 
sure against the angle behind and raise it by working in the back, drawing 
up with the pectoral muscles as before shown. 

Dr. Harry Still frequently works as follows upon the upper ribs; in this 
way you can get your hands upon the first two ribs. He puts one hand be- 
neath the angle of the rib and with the other he grasps the elbow of the pa- 
tient and presses the arm down across the chest, thus springing the ribs out 
and up, and can get quite a leverage in that way. This is very good for 
these upper ribs. In case of overlapping or twisting of the ribs the same mo- 
tions that I have already shown you for raising or lowering the ribs will ap- 
ply. In case you wish to treat the cartilages alone, which you must not omit 
in your examination, it is well to work with the fingers against the cartilages 



143 

in front, drawing the arm up about the level of the shoulder and pushing it 
backward, you thus raise the ribs and free the cartilages, and you can work 
any twist out of them in that way, or work them up or down at the time. I 
have heard that method frequently mentioned by Dr. McConnell. 

As to the lower ribs they may be up or down, or slipped or twisted in 
different ways. One of the best methods is to flex both knees, then by get- 
ing your thumb against the point of the rib which is out you can bring pres- 
sure there, with the fingers of the same hand back of the angle of the rib, 
then by drawing the legs down in this way you can get a stretching motion 
upon the muscles. In case the displacement has been downward by contrac- 
tion of the muscles, you will hold the rib up in that way and thus stretch the 
muscles. Or in case the rib has been displaced upward you must work it 
down as you go by the tension of the muscle in straightening of the knees, 
and by pressure with the thumb. Dr. McConnell has the patient take a deep 
breath, he then in case the rib is displaced downward exaggerates it by press- 
ing it still further downward at the free end and upward at the spinal end, 
and then when the patient lets the breath go he will simply work the part 
up; he thus springs the part, gets a fulcrum by having the lungs inflated and 
allows the rib to take its natural position. You cannot always set a rib at 
the first motion. It will sometimes take considerable attention and consider- 
able length of treatment to affect your object. There is one more method 
which I saw Dr. Charlie Still use the other day for raising the floating ribs, 
or any of the other ribs. This is what you would call a quarter turn. .He 
gets his arm under the legs of the patient and brings him around until he is a 
quarter turned off of the table, then he swings the patient downward, upward 
and back; meanwhile he has kept his fingers against the angles of the ribs, 
and thus pressure of the hand worked them back into place. 

Q. Demonstrate to us the method of giving immediate relief iu severe 
cases of asthma. 

A. Any of the methods that I showed you of raising these particular ribs 
on the right side. 

Q. In case of the eleventh or twelfth rib being pressed right into the 
liver would the motion you gave us bring it out? 

A. Yes sir, by relaxing the unnatural tension no matter which way the 
parts are. These motions were given to either raise or lower the ribs. In the 
first place the motion of extending the limbs will, by the tension brought upon 
the quadratus lumborum, draw the limb down. You also, of course, push un 
der with your thumb, and get it against the point of the rib and work it out- 
ward as you go. 

Q. If one lung were badly diseased would it affect the pulse on that side? 

A. Not particularly on that side, it would probably affect the pulse in 
general, probably make it weaker. 



144 

LECTURE XXII. 

At the last lecture I considered the heart and lungs, taking up first some 
nerve centers for the heart and lungs, showing^ that the theory of our work 
was, first, that we work along the splanchnics, getting a general equalization of 
the circulation, general effect upon the heart and lungs, and further that we 
espcially work in the upper dorsal region for this effect. I also showed you 
the relation between intercostal and inframamnaary pains — pains coming from the 
6th, 7th and 8th cutaneous nerves referred back to the 4th, 5th and 6th inter- 
costal nerves, these connecting with the plexus about the aorta, and also in 
that way with the heart ; also that in the same way a connection could be 
traced from the viscera to these spinal nerves, especially the 4th, 5th and 6th ; 
and explained the visceral pains referred to the surface of the body about the 
shoulders and between the scapulae. Then I mentioned certain accelerator 
fibres for the heart and lungs, and took up the examination of the heart and 
lungs, but had not time to go into the treatment of the heart and lungs. I also 
showed you the different methods of raising the ribs. To-day, m the latter 
part of my lecture I wish to consider the general treatment of the heart and 
lungs. 

Having previously taken up the spine, head, its parts, and the thorax, we 
have now come to the abdonmen, which I wish to consider to-day. First, 
however, some general points concerning the lymphatics. Occasionally the 
question arises in an Osteopath's mind, what is his duty in referece to the lym- 
phatics. What can he do with them? Since they are important in the nutri- 
tion of th? body, how can he gain control of them? Of course, since they 
have to do with nutrition, they are affected by general conditions of the body. 
Anything which affects the general nutrition of the body will affect the lym- 
phatics, and vice versa. You find glands along the lymphatics, conglobate 
glands, as they are called, especially in the neck, although every part of the 
body is supplied with them. I have mentioned the fact that the lymphatics are 
scavengers, and that if you note any enlargement in the neck, it shows some 
trouble in the head. I have one case particularly in mind, a case of measles 
followed by serious trouble of the eyes, where these glands were enlarged, and 
had been so for quite a while. Another case of measles with whooping cough 
had been followed by enlargement of the glands. Another case I noted where 
an operation had been performed near the knee for abscess, it was on a cadaver 
that I saw it, the femoral glands at the groin were still enlarged, that being the 
set of glands in the course of the lymphatics which drained the Ivmph from the 
limb. Of course in tonsilitis, or septic processes, these glands are affected. It 
is well that it is so, for they prevent the passage into the blood of this septic 
matter, which would, of course, result in blood poisoning. In such cases I 
have called to your mind that you must not treat directly over the gland, but 
indirectly, to remove the original cause. 



145 

As to the direct treatment that we get upon the lymphatics, you often find 
that the clavicle is down, and in such case it may stop up the opening of the 
thoracic duct into the subclavian vein, so occassionally we have to look to see 
whether or not the clavicle is lowered. The first rib may cause the same 
trouble by being raised. A tightening of the tissues in these parts may cause 
a stoppage of the thoracic duet or of the right lymphatic duct. Little is known 
concerning the innervation of the lymphatic system. It is known that the 
lymphatic vessels are supplied in their middle and inner coats with involuntary 
muscular fibres. The physiologists tell us that the flow is influenced in three 
main ways : First, the general muscular exercise of the body, aided by the ac- 
tion of the valves in the lymphatics which prevent a backward setting of the 
lymph, helps forward the flow. Another method by which its flow is aided is 
tiie movements of the thorax in inspiration and expiration; the pumping mo- 
tion of the chest. The third way is the vis a tergo. the force of the circula- 
behind — the continual expulsion ol the lymph from the blood vessels forcing 
tlie onward flow of the lymph in the lymphatic system, Of cuurse the flow is 
more restricted by the presence of the glands in the course of the lymphatics. 
Plowever, it is stated that there are certain nerves controlling all these lymphat- 
ics. That there are fibres m the upper cervical region which control the cali- 
bre of the duct. That probably the thoracic duct itself, and the general Ij^m- 
phatic system are under the control of the sympathetic system. And the re- 
ceptaculum chyli is probably under control of the splanchnics directly. There 
is a point at the fourth dorsal called by the "Old Doctor" the center for nu- 
trition. Reworks there in cases of obesity, as well as in the upper cervical 
region. Incases of obesity also there is frequently an enlarged cushion, you 
might call it. of flesh in the upper dorsal region ; j^ou will find that in almost 
every case where a person is extremely fleshly. It is said that the enlargement 
affects not onjy the general condition of the body in that waj^, but the heart 
and the eyes as well, and I have frequently seen it so. Mrs. Patterson, in de- 
scribing the treatment for obesity, said that we treat at this region to reduce 
that cushion of flesh; work also at the 4th dorsal and in the upper cervical re- 
gion, working along the transverse processes, alternately stimulating and in- 
hibiting nerve force, and thus getting an effect upon the thorcic duct. So that 
the Osteopath sometimes works directly to remove some obstruction, as for 
instance, at the clavicle or the first rib, and then the effct that he may get 
through its possible nerve supply, added also to the effect that he gets by gen- 
eral manipulation of the body and the stimultion of the lungs and the working 
of the parts, which would all aid the onward flow. And where the trouble 
with the lymphatic system is due to the general condition of nutrition, there 
he would get his indirect effect by working upon the lungs, heart, bowels, liver, 
kidneys, and all the excretory and nutritional organs. 

As to the abdomen, we know that it is important to us from the fact that 



146 

its contents are so often complicated with disease. It contains important or- 
gans of nutrition. Tliese organs are directly accessable to pressure from the 
outside, hence it is the Osteopath works so frequently upon the abdomen- 
Here I believe, too, we are not in danger of becoming masseurs — simply to 
kneading the abdomen, as you might say, which of course is not the principle 
at all, although we work upon the abdomen and frequently knead it. The prin- 
'^iple is to work for the blood and nerve control, as in other cases : occasionally 
we do use a kneading to force onward the fecal matter in the large intestine. 

The abdomen is important, then, since it is related to the general health, 
and is readily reached by us. The fact, also, that we reach it through the 
splanchnic nerves along the spine, of which I have already spoken, and through 
the solar plexus in front, which we can get by deep pressure makes it an impor- 
tant part to us. When we work upon these nervous connections we have influ- 
enced the various viscera, since they are all connected. 

XL Some nerve centers and nerve connections of the abdominal contents. 
The general facts in this connections have already been considered. I have 
mentioned the effect of abdominal tumors — the fact that a tumor pressing upon 
the sympathetics may produce an effect in distant parts of the body. I call 
your attention again to the familiar splanchnics ; you know where to reach them : 
nervous influence passes from them to the solar plexus, the solar plexus is inti- 
mately connected with the other prevertebral plexuses, viz., the hypogastric and 
the pelvic plexuses, and these in turn are connected with the secondary plexu- 
ses — the diaphragmatic, the superior and inferior mesenteric, the renal, the 
coeliac, prostatic, vesical and uterine, and all the secondary plexuses. So it is 
not strange that, as I stated, there will hardly an hour pass in your practice 
that you will not work upon the splanchnics for something or other. Do not 
fall into the error of thinking that it is only by our work upon the splanchnics 
and the solar plexus that we reach the abdominal organs. Because, as you 
know, this chain of sympathetic ganglia extend the full length of the cord ; there 
are four lumbar and four sacral ganglia, and branches from the lumbar cord 
pass to these plexuses of the sympathetic and have to do with the life of the 
viscera. Sometimes reflected impulses are sent, as for instance, abdominal tumor 
causing hypertrophy first, and then degeneration of the heart. 

However, to take a slightly different course, I wish to call your attention 
to the explanation given for a frequently observed phenomenon, that is, in 
hysteria, frequently a pain is felt in the hip or knee, a cramping of the leg or 
pain on the inside of the knee. The explanation given hy Hilton is as fol- 
lows ; that from the ovaries and uterus, which are supplied by sympathetics. 
branches run back to the sacral sympathetic ganglia, thence oranches run to 
connect these organs and these nerves with the great sciatic and with the ol)tur- 
ator nerve, also with the sacral plexus of nerves. Now, the groat sciatic, as you 
kLOW, supplies the thigh, or at least sends branches to the hip joint, and the 



147 

obturator also has articular branches to the knee joint. Hence, it is not 
strange that uterine irritation will produce a pain along the paths of these nerves 
and may affect the hip or knee-joint or both, or the inner side of the knee. 
The same thing is noted in intestinal disease, where the irritation in the lower 
bowel may send the same kind of an irritation over the same nervous connec- 
tions and on down the leg, and you have a sciatica caused by trouble in the 
bowel. Cases have been noted frequently in our practice, where a pregnant 
uterus or the pressure of a large amount of focal matter will cause a cramping 
of the leg; a twisted ilium would have the same effect. These nerve connec- 
tions are all extremely interesting to us. However, we should not lose sight of 
the main points m our work upon nerve connections ; when we are considering 
nerve connections we are apt to become too theoretical. If we can trace the 
pain up the leg to the sacral plexus and find a twisted ilium, we have done the 
work which is almost peculiar to the Osteopath. And so it is that we must look 
for the original cause, whatever it may be. And remember, please that it is 
very frequently that the Osteopath finds a displacement of parts, and the suc- 
cesses of our practice have been Iragely because we understood where to look 
for and how to adjust misplaced parts. 

In the first few lectures I gave you certain centers which had to do with 
the viscera, for instance, the second lumbar, being the center for partuition, 
defecation and micturition. But there are other nerve fibers supplying these 
part^ which I wish to call to your attention. I noted the fact that the "Old 
Doctor" calls the nutrition center in general from the sixth dorsal down, and 
so you will see that it has to do with the visceral hfe, and hence with the nu- 
trition of the body very largely. Quain, in speaking of the lumbar portion of 
the sympathetics, says that spinal fibers decend in the cord from the lower dor- 
sal region, and that fibers also pass from the first one or two lumbar nerves to 
the plexuses of the sympathetics, and that they carry vaso-constrictor and 
secretory fibers to the lower limbs. These have been demonstrated more 
particularly in animals, but there is not much doubt but that they exist in man ; 
also vaso-constrictor fibers to the abdominal vessels are found in these nerves ; 
iind motor fibers to the circular, and inhibitory fibers to the longitudinal mus- 
cles of the rectum.. From the lumbar nerves w^e get, first, motor fibers to the 
•bladder, they pass down to the hypogastric plexus on the pelvic plexus and 
are then distributed to the bladder. They supply the circular muscles, includ- 
ing the spchincter of the bladder, and probably also some inhibitory fibers to 
the longitubinal fibers of the bladder. In the next place, we get motor fibers to 
the uterus, which follow the same coarse as the motor fibers to the bladder. It 
is a fact that| there are no spinal nerves from the sacral region running to the gan- 
glia of the sympathetic. The spinal fibers which run to the sympathetic gangha 
in this region comes from the lumbar cord or from the lumbar nerves^ and it is 
through the spinal branches of the sacral nerves that we get the effect that we 



; 148 

do by our Osteopathic work in the sacral region. Hence, the importance of all 
the work the Osteopath does upon this region for the pelvic viscera. Frequently 
you work along the lumbar region to get an effect upon the organs contained in 
the pelvis, and it is on account of the sympathetic connection here rather than 
with the sacral cord, that we work here. However, we work also down lower, 
but where we work in the sacral region we get an effect upon spinal nerves. 
The forth sacral nerve, spinal, having branches from the second and third and 
sending branches to the fifth, is called by Gaskell one of the pelvic splanch- 
nics, as it has visceral branches. Having connection with these upper sacral 
nerves it runs out to form a plexus with the sympathetics, and goes to the blad- 
der and other pelvic viscera. And we frequently work over the sacral region to 
release tension there, set the coccyx, or set a slip in the innominate, or remove 
anything which may affect nerve force there. From these visceral branches of 
the sacral nerves we get the following: First, motor fibers to the longitudinal 
and inhibitory fibers to the circular muscles of the rectum ; second, motor fibers 
to the bladder, probably chiefly to the longitudinal muscles. Third, motor 
fibers to the uterus; fourth, secretory fibers to the prostate gland. So here we 
have a rather anomalous condition of working directly upon spinal nerves to get 
a direct effect upon the viscera. You will find that from the sacral fibers, 
through the spinal nerves, we get certain fibers to the bladder and rectum, which 
are contrary in their action to the fibers to the bladder and rectum derived from 
the lower lumbar region, for instance, the fibers to the longitudinal muscles of 
the bladder are motor, while those to the circular muscles of the bladder are 
inhibitory in the case of the sacral nerves. In case of the lumbar, they are just 
the opposite — inhibitory to the longitudinal muscles and motor to the circular 
muscles of the bladder. This applies also to those to the rectum, so that you 
have for the bladder and rectum in one case motor fibers, and in the other case 
inhibitory fibers, and thus you have it under your control. 

The Osteopathic centers for these parts I have already given you. You 
remember that we work there upon the 5th sacral for the spchincter aui, upon 
the 4th to relax the vagina, and upon the 2d and 3d for the spchincter of the 
bladder. In passing I might also call your attention to the importance of the 
fifth lumbar as a center, Important, in the first place, because we so very fre- 
quently get a displacement there, it being the point of weakness, the junction 
of the spinal column with the pelvis ; and important, in the next place, because 
it is a center through which we work to reach the hypogastric plexus. 

III. Landmarks for the Abdomen: — There are certain points about the 
abdomen which may be more or less familiar to yon, which I wish to bring up 
for the sake of refreshing your memory before we proceed further. Thes^e are 
according to Holden as before. The Linea Alba, as you know, extends from 
the apex of the ensiform cartilage to the symphysis of the pubes, and is the 
thinnest part of the abdominal wall. The lina semilunaris extends from a point 



149 

at the level of the anterior end of the seventh rib down to the spine of the 
pubes, bulging outward 5 the parts between them are attached to the linea alba 
and to the semilunaris and are sometimes filled with some extravasation of pus 
or fluid. The linea transversae are usually all aboye the umbilicus, the lower 
one being about on a level with the umbilicus. These lines on statuary are 
almost always exaggerated, making the abdomen of a muscular man look like a 
chess board, which is not correct. These are interesting to us further from the 
fact that any one of these squares marked off by the transversae and linea alba 
may contract, or any one of them may become filled with pus, and simulate 
some deep seated abdominal tumor or other disease. 

Marks About the Pelvis : — In the erect position a line drawn between 
the highest points of the crests of the ilia is just about on a level with the prom- 
ontory of the sacrum. The umbilicus is sometimes stated to be the center of 
the body, but it is a little nearer the pubes than the ensiform cartilage. It is 
not true that if a man should lie down on his back with his arm outstretched, 
a circle drawn with the umbilicus as its center, would just include the extrem- 
ities, bejause this center varies with age. It will be just above the umbilicus 
at birth ; at five years of age it is just at the umbilicus ; and at thirty it is just 
below the pubes in man and just above in woman. Of course it depends also 
on the length of the legs. 

The bifurcation of the aorta is just about the level of the promontory of 
the sacrum, or you might say, level with the highest point of the crests of the 
ilia. The level of the umbillicus referred to the spine is about that of the third 
dorsal vertebra. It is said that, taking a point one inch below the umbilicus 
and slightly to the left, compression may be made upon the aorta. This point 
is taken because above the umbilicus there are structures which might be in- 
jured by deep pressure. By feeling here you can get the pulsation of the aorta. 
Cases are on record where the aorta has been compressed here, under chloro- 
form, for a time sufficient to cure aneurism of the abdominal aorta. The 
umbilicus, as you know, is sometimes pervious, being the remains of the foetal 
artery it sometimes does not close. It is deeper and wider in women than in 
men. As it is sometimes pervious, there may be a hernia here, or escape of 
pus, or of ovarian fluid, or of entozoa. The umbilicus is also a good fixed 
point from whiA measures are taken in case of diseases where it is necessary to 
compare parts of the body. Measurements are taken to the ensiform cartilage, 
to the anterior superior spines of the ilia, or to the symphysis. It is frequenly 
useful in fracture to measure to the anterior superior spines to see how much 
the parts are displaced. In the median line behind the linea alba as we go 
we have first, the liver just below the ensiform cartilage, and extending about 
the breadth of three fingers. Second, the stomach, which, when distended, 
presses the transverse colon down and occupies the space between the umbili- 
cus and the liver. When empty it recedes, leaving a slight hollow on the sur- 



150 

face, '^ the pit of the stomach." The transverse colon, when not displaced, 
the middle of it is just above the umbilicus. You will frequently want to know 
where to find the transverse colon, and you can work on it here with a sufficient 
deg^'ee of certainty. However you must bear in mind that it is sometimes 
slipped out of position, as in enteroptosis. Cases are on record where it was 
found as low down as the floor of the pelvis. Behind and below the umbihcus 
are the small intestines, when they are not displaced by a distended bladder. 
The peritoneum, as you know, is loosely attached to the abdominal wall ; when 
the bladder is not distended this peritoneum is in contact with the linea alba 
all the way down to the pubes. But when the bladder is much distended it 
rises, sometimes half way to the umbilicus, then the peritoneum is pushed back 
by the bladder, and between the peritoneum and the abdominal wall there is a 
space of as much as two inches. A case is on record where in the seventeenth 
century a blacksmith cut open the bladder there and removed a large stone. 
Of course cutting the peritoneum would have been a serious matter. 

When you wish to find the division of the aorta it is a safe way to find a 
point a little to the left of the center of a hne drawn between the highest points 
of the crests of the illia. And, as I said, compression can be made at this 
point. A line bulging slightly outward from this point to where you feel the 
pulsation of the femoral artery will mark the course of the common and exter- 
nal iliac arteries. The first two inches of the hne belongs to the common iliac 
artery. Of course these things vary, the aorta may be longer or shoter, the 
bifurcation coming above or below, or the common iliac may be longer or short- 
er. There is one point in the examination of the the thorax which I failed to 
mention, and that is what is called succussion. When there are fluids in the 
body cavities, especially in the pleura, a quick shake and then the application 
of the ear to the chest wall will give you a splashing sound, and that is called 
succussion. 

Also the Treatment of Mammae : — You will find in your practice that 
the mammae are swollen, inflamed and perhaps caked, or something of that 
kind and especially at the menstrual period. In such cases it is a very good 
plan to free the circulation by spreading the upper ribs both in front and be- 
hind. Raise them well and raise the clavicle, for there ma}' be obstruction to 
the internal mammary artery, especially at the second interspace, where the ar- 
tery perforates and runs to the breast, you will have good success in treating 
such cases. 

General Treatment for the Heart and Lungs: — As I have said, this 
is just the indication of the general treatment. Dr. Harry Still, with whom 
we are all acquainted, said in an article in the last Journal that you cannot give a 
a receipt for each particular treatment and it is foolish to try to do so. It you 
write a receipt and try to follow those directions for any one'caso you arc liable 
to get into trouble because cases vary. As he says, there are Just as many 



151 

nervous systems as there are human faces, and just as many kinds of paraly- 
sis as there are nervous systems. Thus it is that I can only give you the gen- 
eral treatment for these conditons. In treatment of the lungs, I have already 
shown you how to exanine the lungs. Your idea is to work upon the upper 
dorsal region, you know the center is from the 2d to the 7th. However, I 
might say in general concerning the heart and lungs, that they are very closely 
related. When you have trouble with one you frequently have trouble with 
the other, and they are so closely related to the general health, that if you find 
trouble in one place 3^ou had better look also in the other. In treatment of the 
lungs, one of the chief things to do is to raise the upper ribs, get your fingers 
on the angles of the upper ribs and work along, pushing the shoulder down 
and back. Or you can set your patient upon a chair and place your knee in the 
back, or your thumb, in the same way. I have relieved congestion of the 
lungs very readily m that way. 

Also in treating the lungs it is a good idea to get the thumb in between 
the clavicle and the first rib, push the arm across the chest and back over the 
face. That of course separated the clavicle and the first rib. I have noticed 
Dr. Harry Still use that method frequently, and the idea there is to spread 
these parts, give the blood vessels free play — the subclavian, and also we get 
an effect upon the phrenic and the pneumogastric nerves which cross the first 
rib in front of the scalenus anticus. It is also important in working upon the 
lungs to pay attention to the condition of the pneumogastric and of the sym- 
pathetics. Hence it is that we work in the superior cervical region and also 
upon the middle and inferior cervical ganglia of the sympathetics. I have 
already shown you how to treat them. Now, your irritation to the vagus 
may of course be sufficient to produce results in the lungs. It has to do with 
the caliber of the bronchial tubes; it gives them motor, dilator and constrictor 
fibers, so that if it is irritated it may cause contraction and give you a case of 
asthma, or something of that kind. The irritation may be in the stomach or 
in the throat, or anywhere where it may irritate the pneumogastric nerve. If 
the superior laryngeal branch is irritated it may result in catarrhal pneumonia. 
So you must look carefully to the nerves and treat them in the neck at the 
points I have indicated. The third, fourth and fifth cervical are particularly 
noted because any displacement here is liable to affect the sympathetics, 
which has to do with the involuntary movement of the lungs. Then the first 
and second ribs and the fifth rib are particularly noted, but all the ribs from 
the second to the seventh are included, and all the upper part of the spine. 

I might tell you also how to treat the heart ; it is largely a repetition of 
what has been said for the lungs, because the phrenic and pneumogastric also 
supplv the heart, and you must always look to them. We frequently work 
upon the pneumogastric nerve here in the neck, holding against it, thus in- 
hibiting its action, to increase the beat of the heart, because we thus cause the 



152 

inhibitory fibers of the pneumogastric to cease functioning'. That is simply an 
adjutant, as I have said before, we can get a better effect in quietiog the heart 
or stimulating it by working in the region of the splanchnics and along the 
upper dorsal region, especially on the left side. The motions I have already 
given you — any of these spreading motions to spread and raise the ribs, will 
relieve the heart trouble. Of course, as I have said before, I am giving you 
only the general treatment. In any particular case you will probably find some 
one thing the matter, you might find the clavicle down and affecting the heart, 
you might find the first and second ribs up and affecting the heart, and you 
might find any particular rib in the upper dorsal region displaced affecting the 
heart. 

Q. Suppose you were treating a case and the patient would faint on your 
hands, by what means would you bring him to? 

A. A good way is to first get the head of the patient as low as you can ; 
just let it hang over the lower end of the table 5 and to refer to Dr. Harry 
again, he says to slap them, pull their hair or anything to get the blood started 
to the head ; a dash of cold water to the face may be a good thing. 

Q. In case of too much blood to the head how would you go about treat- 
ing it to throw the blood away from it? 

A. I would work first along the splanchnics. 

Q. Stimulating? 

A. Well, yes, that is, I would loosen all the muscles, first, in the back, 
and then I would have the patient turn over and inhibit or press deeply over 
the solar plexus, to get the blood from the head. You will have to find out 
the cause ; the cause may be an impacted colon preventing the circulation in 
the lower part of the body. Or you may stimulate the lungs and get it started 
through the whole body ; your idea is to equalize the blood flow. 

Q. In case of too much heart action, what would be the quickest way to 
reduce it ? 

A. The quickest way that I have found is simply to separate the upper 
ribs and raise them on the left side, and I have done it by the count, I have 
lowered it as much as twenty beats, and it stayed that way until the next treat- 
ment ; when the patient came back two or three days later the beat was the 
same. Of course that is an exceptional case, you cannot alwa5"S reduce them 
that much. 

Q. Please give the treatment to increase the heart beat? 

A. You should desensatize the pneumogastric, thus letting the heart run 
a little faster ; and then you would take this same moveijient, because the ob- 
ject when it is too slow is a stimulation, and by raising these upper ribs, 
wiiether it is too slow, you may increase it, or if too fast you can lower it. T 
have gotten effects either way. 

Q. Do lymi)hatics remain enlarged after the septic (.'onditiou has passed 
away ? 



153 

A. That is a very hard question to answer. I have seen their stay en- 
larged so very long that it looked as if they might, but I do not think they do 
really. They may stay enlarged a long time, but it is possible there is trouble 
there yet, especially if the person is in poor health. 

Q. Why are they enlarged in one place and not in another! 

A. Because certain parts of the lymphatic system drain certain parts of 
the body. 

Q. The treatment you have given would be good also for irregular heart 
action, would it not? 

A. There are so many things that would cause irregularity of the heart. 
As I have said, a stoppage of the subclavian vein causing a periodical empty- 
ing of it, caused by a slipping of the clavicle, would cause the heart to lose a 
beat. An irritation to the sympathetics in the dorsal region would cause a 
constriction of these vessels and thus an irregular filling of the heart, causing 
it to lose a beat. 

(Dr. Harry Still) I will tell you, doctor, when it originates from the stomach 
you can press upon the pneumogastric and quiet it down. Simple pres- 
sure, from two and a half to five pounds pressure, for a minute and a half to 
two minutes. 

Q. Would not that desensatizing movement tend to stimulate the heart? 

A. In what way? 

Q. A desensitization of the pneumogastric. 

A. Not with a slight pressure. 



LECTUEE XXIII. 

To-day I wish to consider further the abdomen and its contents. I have 
already given you certain centers for the vaso- motor control of these parts, 
necessarily so in considering the splanchnics. But there is much more that 
might be said, so I will mention some further fibers which go to these parts, 
which teach us how we can control them. 

First, as to the stomach. We know that we reach it through the solar 
plexus and through the splanchnics, also through the vagi. We must not 
forget in dealing with the stomach that probably Auerbach' s and Meissner' s 
plexuses have to do with it as well as with the intestines. Eobinson says 
that the gastric and intestinal secretions are under the control of Meissner and 
Billroth' s plexus, aided by Auerbach' s plexus. Further, note certain state- 
ments in Howell's Text Book: The mesenteric vessels are under the control 
of the splanchnics, which contain both vaso-dilators and vaso-constrictors. 
The vaso-constrictors for jejunum are up as high as the fifth, and extend from 
there down a ways, it does not state how far. Those for the ileum a little 
lower, and those for the rectum come off still lower along the splanchnic re- 



154 

gion. There are none, however, below the second lumbar. The vaso- dilators 
are present in the same nerves in these regions, and here is a chance to bring 
in a point of whether we inhibit or stimulate. I think we understand fully 
that point, and I do not think you will split hairs over those things. How- 
ever, the vaso -dilators are more abundant in the lower three dorsal and in the 
upper two lumbar. The vasodilator and vaso-constrictor fibers of the 
splanchnics, ending in the solar and renal plexuses, have the vaso-motor 
supply of the liver. The splanchnics contain the vaso-dilators and vaso-con- 
strictors for the liver probably. It is said that there are vaso-dilators also in 
the vagi nerves. However, this matter is not settled, and they are not per- 
fectly sure about the existence of these fibers. However, it makes but little 
difference to the OsteoiDath, since he can rule the flow of blood through the 
liver in other ways, as we shall see presently. 

Then, as to the kidneys, there are vaso-motor fibers from the sixth dorsal 
down to the second lumbar. You know that we can get, more easily, per- 
haps, on the kidneys than on any other organ a vaso-motor effect reflexly by 
the application of cold to the skin. And then by stimulating the sciatic 
nerves it has been found that one can get a vaso-motor effect upon the kid- 
neys. This seems to be in line with what has been said concerning an equilib- 
rium between the blood flow in different parts of the body. There are cer- 
tain centers that the Osteopath works upon. The ''Old Doctor" says there 
is a center in the skin, that is, a peritoneal center, about one inch each side 
of the umbilicus, and that work there is beneficial both upon the kidneys and 
upon the intestines, and we often make a mere spreading motion there at the 
umbilicus, just press in deei3 and spread apart, not hard, for work upon the 
renal veins and arteries. That always seems to have a good effect in treating 
the kidneys. Of course you know the micturition center is the second lum- 
bar, but 3^ou have already been cautioned not to go too much according to 
centers; look for the lesion, which may be some place away from the center. 

As to the spleen, it is found that stimulation of the peripheral end of the 
splanchnics will cause quite a change in the size of the spleen, that is, in its 
bulk, but it is not really known whether it is on account of vaso-motor con- 
trol, or because of an effect upon those involuntary muscle fibers which you 
saw so nicely under the microscope — you know how the capsule and the 
trabecuhe of the spleen are well supplied with involuntary muscle fibers, and 
you remember how the oval nuclei of those fibers are easily seen. However, 
from the Osteopathic point of view, it makes little difference whether lie can 
in one way or the other change the size of the spleen, so long as he does it. 
that is what he is after. He does not care whether it is through muscular or 
vaso-motor conti'ol, or whether he can work upon the splanclinics and tluis 
reduce its size. Should he do that, of course \\c would thus change \ho How 
of blood through it. There is a great deal not understood about the spleen. 



155 

There is a very good Osteopathic point, however, I have often heard Mrs. 
Patterson speak of it, that is, treatment of the spleen in connection with 
treatment for gall stones. She says you can treat for gall stones and remove 
them bnt they will form again unless you treat the spleen on the left side over 
the ninth, tenth and eleventh ribs. And as far as I know that is part of the 
practice. I have not heard that statement refuted by any one. Another point 
as to the spleen — in treating it you will sometimes find it congested; it is like 
the liver in that respect, they are both liable to congestive disturbances. You 
may by working deep in the left hypochondriac region reach the spleen, but 
when the spleen is distended with blood it is said it is very readily ruptured; 
and if you find the spleen enlarged and tender I would advise you to treat 
rather over the back through the spinal nerve supply than over the abdomen. 
I think I might emphasize once more the importance of the Osteopathic work 
upon the abdomen. As I have already said, I think here we are in more 
danger than anywhere else of becoming masseurs. Indeed I do not think we 
need to learn the baker's trade before we can work on the abdomen, and we 
ought to bear in mind that although we knead there, we work there as di- 
rectly as in other parts of the body for nerve control and for the blood 
flow. And the fact that we knead the abdomen occasionally is not any sign 
that we simply knead it as a masseur does. Of course there are times when 
we depend upon the mere mechanical movement, as when we begin at the 
sigmoid and work on back to loosen up the fecal contents, but our chief work 
is upon the nerve supply. I think I have already mentioned the point that 
by work upon the abdominal peripheral terminals we can stimulate or inhibit. 
I merely call it to your mind again, that by getting the peripheral terminals 
in the organs of the abdomen, which we can reach by pressure over the ab- 
domen, and by getting these various plexuses from the solar down, we can 
get an effect upon these organs, and that is what we are reaching when we 
are working the abdomen. For instance, we frequently work along the whole 
length of the great intestine. What are we doing? You will remember that 
Auerbach's and Meissner's plexuses are found, the first between the muscu- 
lar coats, and has to do with the motions of the intestines; and second, 
deeper, in the submucous coat, and has to do with the secretions. Now, we 
may work in the region of the abdomen, and the beginning Osteopath, who 
does not understand, may think he is simply kneading, but such is not the 
fact, we are reaching terminations of nerves. You know what the plexuses 
look like, with their meshes, in the internodes of which are ganglia; they (the 
ganglia) are centers upon which you may work directly by pressure over the 
abdomen. Thus it is, I think, that we get the best explanation in regard to 
the Osteopath's successes in treating abdominal troubles, such as constipa- 
tion, diarrhea, enteritis, and a whole list of troubles which affect man, and 
our success there is marked. Byron Eobinson says: ^'Gastro -intestinal 



156 

secretion appears to be carried on by the Meissner-Billrotli aided by Auer- 
bach's plexus of nerves, which are sympathetic ganglia, automatic visceral 
ganglia. ' ' As I have said, since they are ganglia, they are centers, and since 
they are automatic, they are to a certain extent independent, and that by 
stimulating them, whether we go back to the splanchnics so much or not, 
you get the effect as you have an independent source of nerve supply here. 
Indeed, Robinson in making this statement, is doing so to establish his point 
that the sympathetic is largely independent in its action. We must, however, 
couple our work here with work in other places, and we must not forget also 
that the nerve centers chiefly are along the spine. We do our work largely 
here also by the blood flow. I have emphasized the nerve control and the 
blood flow. Eobinson says that the movement of the intestines is largely de- 
pendent on the amount of blood in the intestinal wall. That is, on the amount 
of fresh blood which affects the parenchymal ganglia. We have a certain 
number of ganglia in these walls; they must be supplied with blood if they 
are to act properly; that is, with good, fresh blood. And by working over 
the splanchnics and by this manipulation process you can throw great quan- 
tities of blood to the abdominal viscera, and thus supply these ganglia with 
an added amount of blood, and that will also help to explain how we get our 
effect upon the nervous system there. And when you have done that you 
rule both secretion and motion. Of course that has to do very closely with 
constipation and diarrhea and those things. Your peristalsis may be too 
rapid, and thus you would have a case of diarrhea, 3r it may be just as rapid, 
but, as Eobinson says, futile, and you will have constipation. You have to 
couple with that work the ruling of secretions through Meissner' s and Auer- 
bach's plexuses, and if they are too abundant you have diarrhea; if deficient, 
you would have constipation. The fact then, there, as in other cases, is that 
we remove lesions and these secretions attend to "themselves, they become 
normal; a change in the amount of motion and a change in the quantity or 
quality of secretions; so we work toward the normal. We might repeat this 
for every organ in the abdominal cavity. When we work for the uterus, the 
bladder, or in the intestines, or the ovaries, Ave work very largely through 
the nerve control, as is evidenced by the fact that in case of those organs we 
work generally through the spine, along the lower part. It might be thought 
that the motions we employ in our work upon the liver are exceptions to this 
rule, but I think not. We frequently work against the lower edge of tlie 
liver, but we cannot work much of its bulk by our direct kneading motion 
there, and I think what we do there is the same as elsewhere, we affect the 
nerves as well. We affect the hepatic plexus of the sympathetics directly by 
manipulation there, and indirectly through the solar plexus, also through the 
splanchnics, and the vagi. If you will watch Dr. Harry Still yon will see 
that he will scarcely ever omit to treat the vagi, when treating the liver, as it 



157 

contains vaso- motor fibers lor this organ. So our work in kneading is largely 
work upon nerve connections. There is a good point that I would like to 
note in speaking of the liver. I have seen a case in which there was 
hemorrhages from the lower bowel; whenever the trouble occurred there 
would be a tenderness and trouble about the liver, and the portal circulation 
would be stopped. There is a close connection between the portal circulation 
and hemorrhoidal. Here you have this great amount of blood which must 
pass to the abdomen and through these terminal vessels, and which must find 
its way back through the portal circulation and through the liver to be 
worked upon by it. These hemorrhoidal veins connect with the portal veins; 
so that if you have an obstruction in the liver you are very apt to find trouble 
in the way of hemorrhoids, piles, or something of that kind. So remember, 
please, that there is a further object in freeing the splanchnics, as a regulative 
process. You might say that this is true, but you might go farther and say 
that the liver in this case is a ''stop cock," that it is sometimes turned when 
it should not be, and is stopping the blood and you have a congestion of 
blood at the lower bowel. You remember that the liver is particularly liable 
to congestion, and if it is congested the blood flow is retarded and you have 
a series of abdominal troubles. 

II. Landmarks foe the Abdomen. — I began this last time, and wish 
to continue them to-day. In examining a patient, as you all know, perhaps, 
it is best for abdominal examination and treatment to have the patient flat on 
the back; have the thighs flexed a little to relax the abdominal muscles; have 
the head and neck slightly elevated, as much as it is raised by this table, this 
will help to relax the recti muscles. Thus you have everything relaxed, and 
unless the abdominal wall is unusually tense through its own condition, you 
have a good place to work. Then in working, I believe that beginning Os- 
teopaths ''dig" here perhaps as much as in any other place. That is, they 
use the ends of their fingers. N^ot only Osteopaths but surgeons make the 
statement that that is very wrong. Holden says to use the tips of the fingers 
causes the parts to contract. Thus you defeat your own object. You should 
lay the flat of the hand on the abdomen. I have seen the worst digging over 
the abdomen, and it is wrong, because you are not kneading and you cannot 
force any condition there, and you had better not try. Dr. Hildreth always 
emphasizes the point that in working upon the abdomen you must work for 
nerve influence; and that is especially noted in typhoid fever, where you have 
an ulceration in Peyer's patches, and if you try to work matters along me- 
chanically, you are liable perforate the ulcerated places. 

The central tendon of the diaphragm is about on a level with the lower 
end of the sternum, about the level of the junction of the seventh costal carti- 
lage with the sternum. The right half of the diaphragm will rise as high as 
the fifth rib when the diaphragm is extended, and to one inch below the level 



158 

of the nipple; rather higher than one usually expects to look for it. The 
position of the abdominal contents is variable. There is quite a contrast, 
says Looniis, between the examination of the contents of the thorax and those 
of the abdomen. In the first instance you have close walls and contents 
which may vary but little, especially under physiological conditions. While 
in the other you have lose walls, you have numerous organs, some of which 
at least, vary considerably within physiological limits. So you see it is a 
different matter when you go to the abdomen to examine or treat it, and you 
must constantly guard against wrong diagnosis by being mistaken which 
organ is at fault. Then, too, the action of the abdominal organs is more or 
less peculiar. Take the stomach, at different times it changes its position 
when it is distended; so it is with the bowels; and according to the position 
they assume, the others are also displaced; so you must bear that in mind. 

I wish to simply call to your attention the regions of the abdomen. You 
know that it is divided into three zones — the epigastric, umbilical and hypo- 
gastric. The epigastric region is bounded above by the diaphragm, below by 
a plane passing from the anterior tips of the tenth rib, and between the bodies 
of -the first and second lumbar vertebrge behind. That zone is divided into a 
right and left hypochondriac regions, behind the false ribs, and the epigastric 
zone, between the umbilical zone is bounded above by the epigastric and below 
by a plane passed from the highest points of the crests of the ilia, striking a 
point between the first and second sacral spines behind. And the lower, or 
hypogastric zone is the one below the umbilical, and occupies the region of 
the pelvis. These two zones are each divided into three by an almost vertical 
plane on each side, passed from the prominence at the tip of the tenth rib to 
the pubic spine, so you have two planes. In the middle zone the regions 
are the right and left lumbar and the umbilical, and in the hypogastric zone 
the regions are the right and left iliac and the pubic. The lower zone is 
bounded below by the upper edge of the pubes and by the two Pouparts's liga- 
ments, one on each side. It will not be necessary to detail the contents of these 
regions, I will refer to the contents as it becomes necessary, later. 

As to the liver, it is found mainlv in the right hypochondriac region and 
extends across into the central or epigastric region, and as far toward the left as 
the mammary hne. It may extend down two or three inches, and at this point, 
behind the linea alba and the median line is the best place to find the liver ; it 
protrudes half way to the umbilicus, but you will not be able to find it until 
your hand is educated. Of course the liver may protrude lower in disease. 1 
have seen a liver that weighed sixty pounds ; they become enormously large at 
times. It may extend down, as for instance in tight lacing, when it is not dis- 
eased, and you will have to judge what the general condition is. On the right 
side, where it goes a little higher, it may ascend as high as the diaphrani. about 
an inch below the nipple, and below, at the lower edge of the lung, or :is low as 



159 

tbe tenth dorsal spine. The liver, remember, is a very important organ. I do 
not think that with all that Dr. Harry Still says about the liver it is any to 
much impressed upon our minds, because it is extremely important to us in our 
practice. The gall bladder you will find just beneath the tip of the ninth rib on 
right side, but it is behind the liver, and you are not able to find it, and it is 
only when distended to a great degree that it can be noticed ; even that you do 
not feel it directly. But we work there to get an effect upon the gall bladder 
and press its contents out. We work down that duct in a reversed "'S" shape 
to the umbilicus, a little to the right. 

The stomach is one of the most variable organs of the abdomen. You all 
know how much it descends at times when distended with gas or over distended 
with food. At that time instead of simply descending, it turns on its axis and 
the greater curvature comes to the front, because the greater curvature is not so 
strongly attached as is the lesser. When the stomach becomes thus distended 
it will push away those organs m front, and even may occupy all the space from 
the lower edge of the liver or the tip of the ensiform down to the umbilicus, 
and in such a case you are likely to have great dyspnoea and palpitation of the 
heart. I remember a case in which about three hours after a meal, the gentle- 
man had eaten rather hearty, he nad great distress in breathing, and his heart 
was palpitating, and he thought he would die surely. He called an Osteopath 
for heart trouble, but the Osteopath worked the undigested food on through 
the pylorus and worked the gas off of the stomach, and the man's heart was 
all right. You will frequently meet that sort of a case, and if you know 
the probabilities you can be on your guard against it. The cardiac orifice is 
just below the cartilage of the seventh rib where it joins the sternum, and a 
httle to the left. The stomach when empty retreats behind the liver and lies 
fiat, there is no cavity whatever in it. This reminds me of a statement made by 
Dr. Eckley frequently, that naturally these are but potential cavities. The 
oesophagus when not occupied by the passage of food or drink lies with its in- 
ner surface in contact, it simply collapses and occupies as little room as possi- 
ble. The same is true of the stomach. The pyloric orifice of the stomach is 
found on the right at the edge of the sternum about the point where the carti- 
lage of the eighth rib joins ; it is behind the liver and cannot be felt unless it is 
enlarged by disease. 

The spleen is on the left side, below the ninth, tenth and eleventh ribs, 
sounded by percussion over the tenth and eleventh ribs. I have already given 
you some precautions concerning it. It may become very much enlarged, then 
you can readily feel its edge, but unless it is enlarged you do not feel its edge. 
However, you can get indirect pressure on it under the edges of the left lower 
ribs. It is forced down sometimes in full inspiration. 

The pancreas is not very easily felt ; it lies behind the stomach, transversely 
and crosses the aorta and the spleen at the level of about the second lumbar ver- 



160 

tebra. I mention its not because you will find it often ; you can feel it only 
when the abdomen is very thin and the stomach entirely empty; in some cases 
of thin individuals you migbt mistake it for aneurism of the abdominal aorta, 
or you might take it for some disease of the transverse colon. 

The kidneys also are not readily felt. It is said by Holden that he does 
not know that he has ever felt the rounded ed^e of the kidney, but he says it is 
accessible to pressure at the outer edge of the erector spinee muscle between the 
lower ribs and the crest of the ilium. It is accessible to pressure because you 
can get indirect pressure and can know when it is tender. Of course it is 
sometimes enlarged and can then be felt. It corresponds in position to the 
lower two dorsal and upper two lumbar vertebrae. A point to know m relation 
to it is that it will sometimes deceive you, or you will feel masses of hardened 
fecal matter and think they are the kidney, or vice versa ; you must distinguish 
between them. 

As to the large intestine, you are familiar with it. The caecum and iiio- 
caecal valve both lie in the right iliac fossa, and in the right lumbar region and 
over the right kidney runs the ascending colon, and across just above the um- 
bilicus for two or three inches you find the transverse colon ; the descending 
colon and sigmoid flexure are in the corresponding portions on the left side. 
You can reach all of the colon except the splenic and sigmoid flexures. How- 
ever, these are sometimes prolapsed, sometimes sunken, as Robinson states. 
Dr. Tull, of our own practice, has pointed out that this is frequently the case, 
and that prolapsus may cause constipation by acting as a mechanical hindrance 
to the passage of fecal matter along the bowel. You all know the relations of 
the bowel, and except at those two points you will be able to work upon the 
intestine directly. 

As for the small intestine, the jejunum lies in the region behind the um- 
bilicus and is the part concerned in umbilical hernia, and it is because it seems 
to be so particularly vital that umbilical hernia is so often fatal. The point 
oonserning the ileum is that it contains Peyer's patches, which are inflamed and 
ulcerated in typhoid fever; they are in the lower part near the ilio-caecal valve, 
and just at the edge of the right iliac fossa. You will have to be extremely 
careful in treating inflammatory conditions of the bowels, especially in typhoid 
fever and enteritis. 

The bladder is contained within the pelvis except when distended. It may 
become over distended and rise out of the pelvis as high as the umbilicus. 
And as I noted at the last meeting, when it rises it pushes the peritoneum back 
away from the wall of the abdomen, and sometimes will leave a space as groat 
as two inches between them. 

I thought I had better finish the subject in this way to-day. leaving the 
practical examination and treatment of each one of these important organs of 
the abdomen until next time, and I shall try to finish this subject then. 



161 

LECTUEE XXIY. 

At the last lecture I considered the abdomen, taking nrst certain centers 
and nerve connections for the contents of the abdomen — the stomach, intes- 
tines, liver, kidneys, spleen, and so on, calling to your attention the fact that 
although we often work mechanically upon the abdomen, our chief treatment 
there is nevertheless for the reaching of blood and nerve supply, taking es- 
pecially the case of the liver and of the bowels in constipation. I then took 
took up certain landmarks for the abdomen. I wish to-day to carry the sub- 
ject further. 

I. Examination and Treatment of the Abdomen and its Contents. In 
this I do not include the pelvis and its contents, as I shall give a further lec- 
ture, taking up the pelvis and the displacement and treatment of its contents. 
Of course any one of these various organs becomes complicated with disease, 
and the manner in which it is reached and treated in the various diseases 
might well take up a lecture, but I think it best to run over the abdomen and 
its contents, giving the Osteopathic treatment for each different organ to-day. 
perhaps with the exception of the kidney, which I will take up at the next 
time. 

First, as to the examination of the external parts of the abdomen. I 
called your attention at the last time to the need of having the patient raise 
his knees, thus flexing the thighs slightly, also the fact that our tables raise 
the head and chest a little, thus relaxing all the parts about the abdomen, 
leaving the abdominal walls relaxed, so that you can readily examine them 
by touch. You should also take care to see that the patient is evenly disposed 
on each side, so that there would be equal tension of the abdominal walls. 
Of course you see at once that it is necessary to have the parts equally dis- 
posed. We use the ordinary methods of examination of the abdomen — in- 
spection, palpation, mensuration, ausculation, succession and percussion. 
We use palpation and percussion probably most frequently. The Osteopath 
depends upon touch largely, and also upon getting the sound by percussion 
from the different viscera, so these two are the most important methods of 
examination that we have. We should first inspect the abdomen, this is 
best done next the skin. We note its general appearance; you will find in 
some cases enlargement due to inflation from gases in the bowels. In such 
cases it is very likely to be even. However, some of the hollow viscera, as 
far instance, the stomach, may be inflated with gas, in which case you would 
have an uneven enlargement. Further, upon inspection you will find whether 
or not any one organ is enlarged. Sometimes the spleen enlarges enormously 
and pushes farther and farther down through the abdomen, and makes a bulg- 
ing enlargement in its locality. Sometimes, as I have said, the stomach is dis- 
tended with food or with gases, end quite enormously so. Sometimes diseases 
of the liver cause it to enlarge, as for instance in sclerosis of the liver. The 



162 

liver protrudes down below the ribs from enlargement and makes a protrusion 
of the abdominal walls, as does also enlargement of the ovaries, and so on. 
So you should note whether or not the enlargement is equally disposed, as in 
gases in the intestines, or is at a fixed point, in which case you will learn by 
other methods how to tell what organ is affected. 

We should also note the temperature, whether or not parts are cold or hot. 
It is said that in liver troubles there are often cold spots upon the surface of 
the body, and we know that in cases of obstruction to the nerve supply at the 
spine, you can trace the cold streak on across the body. 

Inspection will reveal to you the color, which is significant. In some 
cases the linea alba becomes pale, or there may be splotches of yellow color as 
in some diseases of the liver, jaundice, and in other cases. In pregnancy the 
abdomen assumes a different color, brown, yellowish or black ; it differs ac- 
cording to the person. You can make out the outline of any organ and locate 
it by the other methods of examination. 

The abdomen may be distended or it may be retracted, as in tubercular 
diseases of children, where it is said the abdomen is retracted. And you will 
frequently find in your practice that in thin, emaciated people, any disease 
that is wasting is liable to contract the abdomen. You will also find that in 
some cases it is distended. In diseases which affect the thorax causing pain 
upon respiration there is likely to be a change in the abdomen — anything like 
inflammation of the pleura or pneumonia, there is restriction of motion and pain 
on the side affected. On the other hand, in the abdomen when you have 
trouble which would cause pain upon motion, as for instance, in peritonitis, 
you have the restriction of motion there, and increased motion in the thorax. 
You can also by this examination occasionally note changes, even through the 
wall of the abdomen, as in cases where the heart has been displaced by some 
disease in the thorax. In cases of aneurism of the abdominal aorta you can 
find the pulsation of the tumor. You can feel it very frequently, and it will 
sometimes become so marked that you can detect it on inspection. The caput 
medusae, or litttle web of veins about the umbilicus may become enlarged and 
engorged with blood, indicating that somewhere the blood is interfered with ; 
it is usually in the liver, as in case of scirrhosis of the liver, but it may be in 
some portion of the ascending vena cava. 

Palpatation, as I have said, is important to the Osteopath. You can feel 
the different solid viscera in the different parts of the abdomen. As I have 
already mentioned, 3^ou can feel whether or not there be tumors of any kind in 
the abdominal wall ; you can by touch differentiate between those in the wall 
and those in the organs ; you can tell whether or not they are superficial or 
deep, fluctuating or solid. A solid tumor will give a sound as you get over the 
liver — a flat sound ; a liquid tumor will give also a flat sound, but will give in 
addition a fluctuation, which can be detected by palpatation. When the abdo- 



163 

men has its walls retracted it is likely to be tense, when extended they are also 
likely to be tense. In other cases you may find them very flabby, very loose, 
without tone. In one case there may be too much life, in the other case a lack 
of life or nerve force, and you can detect that by the feeling. You can also 
detect displacement of parts : you must examine to see if the parts are in their 
normal position. The liver, of course, ma}" descend considerably 5 the 
stomach may be displaced until it is resting^ upon the floor of the pelvis. The 
spleen may be enlarged and come far down. Any of the organs may indicate 
pathological changes, or be displaced or enlarged. The transverse colon, you 
know where to find It, just across above the umbilicus. It sometimes becomes 
loaded with fecal matter and descends, dragging with it the splenic and hepatic 
flexures, and in such case you will be able to make out those flexures. You 
will also be able to make out fecal tumors — accumulation of fecal matter in the 
large intestine. If there be pain in the stomacn, and it increases upon pressure 
over the pit of the stomach, it is said to be infiammator}^ as in catarrh of the 
stomach ; if it ceases it is said to be nervous. 

As I have said, the method of percussion is an important one in examin- 
ation of the abdDmen. In general, percussion over parts which are distended 
with gas, gives a tympanitic sound of the abdomen, because there the gas is 
restricted within limits. Over a stomach or bowel distended you get a tym- 
panitic sound. Over the parts contained in the abdomen you get a varying 
character of flat sounds. For instance, over the liver, you know it is best 
reached right in the median line, below the ensiform cartilage, we get a flat 
sound. Here, however, over the lung, you get a higher, more resonant sound. 
You can compare sounds in that way. Over the region of the spleen we get 
the same flat sound; over the region of the stomach likewise. Over the in- 
testine, the same, except the note is of a little higher quality. Eemember that 
in using your left hand as a pleximeter it is best not to place the whole hand 
on the abdomen, place the middle flnger on the abdomen, and then bring the 
fingers of the right hand into line, or take the middle finger of the right hand, 
and tap gently for superficial structures, and for deeper structures moie 
strongly. 

Measurements are used but little in our examination of the abdomen, but 
you can take the umbilicus as a fixed point and measure from it to the an- 
terior superior spines of the ilia, to the end of the ensiform cartilage, or to 
the symphysis pubis. 

Auscultation is made little of in the books. How^ever, I think we use it 
more that the old profession: it is said it is of little use. Dr. Harry Still uses 
it very frequently in cases of liver trouble. He says if he finds a gurgling 
sound over the liver, there is trouble there. That that gurgling sound in- 
dicates that there is an obstruction to the portal circulation. I have often 
been able to hear this gurgling sound. It will be quiet for a while and then 



164 

you will liear a gurgling, and it will be quiet again and you will hear the 
gurgling again. Of course I am awai'e you might confuse this with the bub- 
bling of gases in the stomach, but you will have to learn by general indica- 
tions what the probabilities are. However, I think ausculation in that way 
over the liver is useful to us as Osteopaths. Ausculation is also employed to 
hear the fetal sounds in pregnancy, we will take that up later. Please re- 
member also that you must take into consideration the conformation of the 
spine, thorax and pelvis, take all these parts which will in any way affect the 
abdomen into consideration in your examination. 

It is difficult to say just how to give a general treatment for the abdo- 
men, because we usually treat there for a specific object. However, as far as 
a general treatment would go in the abdomen, it would relax the walls. I 
would simply lay my hands on the abdomen firmly; I would not take the tips 
of my fingers, I would not dig, I would keep my hands straight in that way; 
you know the importance of that. Thus you can thoroughly relax all the sur- 
face of the abdomen. We know this is a very effective movement; it is hard 
to explain. As I said at the last lecture, I believe that the movements there 
stimulate the nervous mechanism in the abdomen more than anything else; 
and mechanically of course we cannot help but work the blood to the parts. 
It is said to be very beneficial. It is recommended by physicians in general 
just to tap the abdomen lightly all over. The masseur works the abdomen 
considerably in case of constipation, and that mechanically excites a flow of 
blood. That is, if it is mechanical, but it is hard to believe it is very largely 
in that way. There is also another movement we might include in the general 
treatment of the abdomen, that is, a lifting up motion, you can thrust your 
hands down in deep in the iliac fossa, and raise everything there. You can 
in that way raise the uterus, bladder and bowels. That is frequently an ex- 
cellent method of treatment and has been used with great success. 

Next as to examining and treating the important organs contained within 
the abdomen. First, as to the stomach. It is hard to confine yourself to a 
particular part. The stomach, for instance, gives symptoms in all parts of 
the body. We should notice the face, the expression and the complexion; 
there may be lack of color, a yellow or clay colored complexion. Also notice 
the eyes, the odor of the breath, the appearance of the tongue. All these 
things are indicative in troubles of the stomach. Also, of course, vomiting, 
the belching of gas, and so on. But these things are so familiar to you that 
I need but mention them to you in the treatment of the subject in this way. 
However, more particularly as to the stomach locally. Of course you have 
the point already that you can see by inspection wliether or not it it enlarged. 
You can also notice by palpation whether or not it be enlarged, by percussion 
whether or not it is caused by. solids, fiuids or gases. Now, in treatment of 
the stomach, you know already that our chief treatment is over the splaneh 



165 

nics; I have already indicated to you the manner in which we treat the 
splanchnics. We also go to the solar plexus, treating by pressing in deeply 
below the end of the sternum, over what is called the pit of the stomach, a 
pressure of five, six or eight pounds, and thus impinge upon the solar plexus, 
and you thus get an effect on the stomach, since the plexus has control of the 
coeliac blood supply, as well as various other blood vessels in the abdomen. 
Sometimes we treat the stomach mechanically by raising the ribs, as we would 
on the right side in liver trouble. It is the usual motion of raising the ribs. 
Or you can set the patient up, have him take a deep breath and put the fin- 
gers in gently under the ribs and raise upward and outward, thus freeing the 
parts in that way. Of course in any treatment we wish to reach the splanch- 
nics, the solar plexus, and it is said there is an important point in the neck. 
Of course we also reach the vagi along the sides of the neck and behind the 
clavicle, where the vagus crosses the first rib. At the atlas it is said a dis- 
placement to the right will interfere with the right vagus. In the case of 
nausea we inhibit upon the left side between the fourth and fifth ribs. You 
know how to find these interspaces. I simply thrust my thumb into that in- 
terspace. The spine of the scapula is opposite the third, then coming down a 
little over an inch, you will readily be able to find where the interspace is; 
then you must raise the arm a little, just enough to relax those parts, and 
thrust the thumb deeply in that interspace. That is one way of treating 
nausea, but it depends upon the cause. I have had cases of nausea in which 
that would not succeed, the pressure gave no relief, but general work upon 
the splanchnics would give relief. That was a case where the patient was 
easily susceptible to congestion of the stomach, and such treatment, coupled 
witQ treatment of the vagi in the neck would always give relief. Treat in gen- 
eral the back from the third or fourth dorsal down to the tenth, eleventh or 
twelfth. Displacement of ribs may cause the same trouble, and you may also 
find a contracture along the spine on either side which will cause trouble with 
the stomach. I treated a case some time ago in which the only lesion I could 
find was a contracture of the muscles on both sides, there was a little heaviness 
of the stomach, which disappeared on treatment. You may find exquisite ten- 
derness over the region of the stomach, and you can see on pressure whether or 
not that may be nervous or inflammatory. When you have gas in the stomach 
it shows there is a lack of life in such a way as to allow the food not to be digested 
and pass on in the usual way, but to be retained and thus to ferment and form 
gas. It is said to free the stomach of its contents to inhibit the pneumogastric 
between the fourth and fifth ribs, as I have shown you, and in that way you re- 
lax the pylorus and allow the food and contents to pass off. Or you can also 
do the same thing by mechanical work. I thrust my hand under in this waj'- 
and work toward the large end of the stomach ; I then bring pressure gradually 
toward the pyloric end, in that way you can force^onward the contents of the 



166 

stomach. You work thus over the ribs ; you can press the ribs down in that 
way and get quite a pressure, and you can also, in the median line, work very 
carefully on the abdomen ; you can thus work the gas or liquid from the stomach. 

This deep pressure over the solar plexus, as I have already shown, is 
said to be very efficient in case of bloating with gas. In some way the stim- 
ulation of the plexus allows the gases to be condensed, and that is one of the 
efficient treatments in cases of gas on the stomach or bowels. The ninth and 
twelfth ribs on the left side have been found displaced m some cases. In cases 
of pregnancy, menstruation or such troubles, you will frequently find a sick 
stomach. Of course that is reflex. To treat a sick headache which is caused 
from the stomach, you must first apply your treatment to the stomach, and 
thoroughly stimulate the parts there before attempting to work on the head. 
In cases of female troubles, you may give relief there, and it is well to do 
so, but of course you must work upon the local trouble at its appropriate cen- 
ters to relieve it. 

Now, as to the liver. First as to its examination ; you cannot see any- 
thing by mere inspection ; the best way is to percuss the region of the liver. 
If you find behind the linea alba that the left lobe comes down as much as 
three inches, the liver is either prolapsed or enlarged, and you will have to de- 
termine which is the case. By percussion along the lower edge of the ribs and 
up over the ribs as high as about an incli below the nipple you can make out 
the outhne of the liver. You will also frequently find that it is quite tender, 
and it becomes extremely so in some cases. Dr. Harry Still says that in case 
the liver is extremely tender he always looks for diarrhoea. The easiest place 
to find whether or not the liver is tender is in the median hue behind the linea 
alba. Of course the liver is complicated with general troubles, as for instance, 
in constipation and diarrhea ; these two things indicate the derangement of the 
liver. In diseases of the liver you will frequently notice yellow splotches upon 
the skin, perhaps on the face, perhaps over the abdomen ; you will find a rush- 
ing of blood to the head, double vision, or day blindness. You must learn in 
general what the cojnphcations are, when the liver is deranged. I have noted 
already the fact that auscultation is frequently used in examination of the liver. 
Just place the ear very lightly over the region of the liver, just at the edge of 
the liver you will be able to make out a gurgling if there be such there. 
Now, as to the treatment of the liver itself. I have already shown you how v^e 
treat the liver — the raising of the ribs as shown here ; or have the patient take a 
deep inspiration, and then raise the points of the ribs. Dr. Harry Still fre- 
quently employs that method — just reaching under the tips of the ribs ami 
raising them upwards and outwards. Of coursh you will have to be careful in 
doing that. We also work upon the liver frequently in this way: You can 
place one hand beneath and tnus raise the side of the chest toward you, and 
with the other hand press down with the Hat of the fingers against the liver. 
Thus you can press the ribs down, and this motion is very gcu^d. 



167 

I explained what I believed to be the theory of such work the other day. 
Qf course in treating the liver we must remember that there are vaso-motor 
fibers in the pneumogastric, and we must not omit to treat it. We also treat 
the splanchnics, as it is also controlled by sympathetic supply; also the solar 
plexus. Those are the chief points for reaching the blood and nerve supply of 
the liver. Also the point that 1 gave you, upon each side of the umbilicus, it is 
said that pressure here applied not too deeply, a fairly firm pressure, will reach 
those centers and irfluence, first, the kidneys : second, the liver; and third, the 
bowels ; you can ^et an influence upon all those organs in that way. 

As to the gall bladder and duct, they are extremely important to us. As 
I have said, the gall bladder is behind the li^er here at the point of the ninth 
rib on the right, but we can get indirect pressure upon it by working up under 
the point of the ribs, for instance, you can sometimes feel the prominence 
made Dy the fundus. The first thing m working upon the gall bladder is to 
work against its fundus, and we can work upon it by working up under the 
ejids of the ribs. The duct we have already spoken of, it lies upon the right 
in a reversed "S" being just over the umbilicus, to the left, and the lower 
limb of the ''S" around the umbilicus to the right where it empties into the 
duodenum. Since the gall bladder and its ducts are both lined by mucous 
membrane and like mucous membranes in other parts of the body it is liable to 
catarrh, it follows that catarrhal inflammation may sometimes travel from the 
pharynx, through the oesophagus, stomach and intestines and up into the gall 
bladder. You will then have an increased secretion of mucous in the gall 
bladder and duct, and may have a mucous plug shutting up that duct, result- 
ing in jaundice. Or you may have a gall stone formed, said to be a precipita- 
tion of the cholesterine of the bile ; these solidify and close up the duct. In 
treating for them we work as I have shown you, against the fundus of the 
bladder and along down the duct, simply trying to force them out. Some- 
times they are quite hard, and at times they are quite soft and can be 
crushed in the duct ; this has to be done without any violence, however. It is 
said that in treating for gall stones, you should not end your treatment without 
raising the ninth, tenth, and eleventh ribs on the left side for the spleen ; that 
stimulation of the spleen seems to prevent their formation, and results gotten 
there seem to prove that line of argument. 

Q. In case you were treating the vagi in the neck and the patient should 
be taken with a nervous chill or something of that kind, at what point would 
you treat to counteract that? 

A. I would treat along the spine, a general treatment. It is said that a 
rubbing up the spine in this way is good for a chill, and I would work there 
for a chill, stimulating also the heart and lungs to stimulate the circulation. 

Q. Has it been the experience of Osteopaths that by stimulation of the 
vagi it would increase peristalsis of the large bowel, and stimulation of the 
great splanchnic would decrease it? 

A. Yes sir, that has been the experience. 



168 

LECTUEE XXV. 

At the last lecture I took up the examination and treatment of the ab- 
domen and its contents, first showing you how we treat to affect the abdomen 
in a general way, and then I started to take up the contents of the abdomen 
one after another. I thought I should get as far as the intestines the last 
time, but failed to do so, and that will be included in to-day's lecture. I will 
also take up the consideration of the pelvis to-day. 

I. Some nerve connections and centers for the intestines and pelvic con- 
tents. I have already mentioned some centers, in the list given, and we 
should always consider those centers along the spine in connection with the 
different parts. There are certain vaso- mo tor fibers noted in Ho welFs Text 
Book: First, for the external genital organs there are two groups, one com- 
ing from the lumbar region and the other from the sacral region. Those of 
the lumbar region from the second, third, fourth and fifth lumbar nerves, run- 
ning forward in the white rami communicantes; they pass through the pelvic 
plexus, and thus reach their termination. You will see later that this pudic 
nerve is important to us in our treatment; you know it contains some vaso- 
motor fibers for the external genitals. As for the sacral group, these leave 
the anterior roots of the nerves in the sacral region. A stimulation here 
causes a dilation of the vessels of the external genitals. As to the internal 
generative organs, vaso -constrictors for the Fallopian tubes, uterus, and 
vagina in the female, and for the seminal vesicles and the vasa deferentia in 
the male, are contained in the sacral nerves. Also we get some fibers from 
the second, third, fourth and fifth lumbar nerves, just as we had vaso -motor 
fibers for the external genitals. We want to know the following points: that 
the second, third, fourth and fifth are the same for the external and internal 
genitals; that we get vasomotor fibers from both; that we also work, as you 
will see later, in consideration of the pelvis contents, frequently upon the 
sacral region, springing the sacrum, relaxing the ligaments about it, and also 
stimulating the peripheral terminations of the nerves in the muscles along 
the sacral region. It is said that the first point to which one should go in 
treatment of female troubles is the fifth lumber; that that is the important 
point, not particularly an important center, but the place where it seems a 
displacement is likely to occur. Then, too, you know that that is the center 
for the hypogastric plexus. The next important point is the second lumbar, 
which is the center for blood supply to the uterus. After that in treatment 
of female troubles the next important point is between the tenth and eleventh 
dorsal vertebra', the blood supply to the ovaries. Hilton makes a [)oint that 
the muscular abdominal walls, the peritoneum lining all these walls, and the 
skin over them, are supplied b>' branehes of the same nerves, as we have al- 
ready mentioned the point that he makes that a joint, the muscles niovinu the 
joint, and thi^ skin covering the insertion of those muscles, are all supplied 1>> 



169 

branches of the same nerve. Hence, it is, he says, that retraction of the ab- 
dominal wall and great tenderness of the skin over the abdomen is found in 
cases of peritonitis, the inflammation reaching the terminal filaments in the 
peritoneum, extending thus from the branches irritated, the sensory branches, 
to the motor branches, causing the abdominal walls to contract, influencing 
also the external cutaneous branches, causing a feeling of pain upon touching 
the abdomen. That brings to mind the point that has already been men- 
tioned to some extent, and which was brought up in clinics not long since. 
The question was, can you impinge upon the sensory part of a nerve and 
thus affect its motor fibers. I think that such points as this answer that very 
clearly. Hilton also instances a case of peritonitis, in which the cause was 
obscure. It was not severe, but it was hard to tell at first that it was 
peritonitis. The patient had been having pain in the abdomen, it was bi- 
lateral, there was no heat at the part; he therefore decided that the cause was 
either central or was dDuble, and since there was no heat there, he examined 
for spinal trouble. He examined thoroughly, but could not find any evidence 
of disease of the spine; he then made his examination for fluid in the ab- 
dominal cavity, and found that there was fluid in the abdominal cavity irri- 
tating the nerves and causing this pain upon the abdomen. 

In considering the pelvis, I though it would be interesting to bring out 
some further points considering nerve connections there. I noted the point the 
other day that in trouble of the uterus, ovaries, etc., the sympathetic filaments 
supplying these parts carry the irritation back to the spinal nerves, and thus it 
may go down the sciatic, or might influence the mucles at the lower part of the 
spme, causing lameness there. A further point is noted with considerable in- 
terest, and it may be useful to us in many cases. Hilton noted a case in which 
a gentleman came to him with what he supposed to be trouble of the bladder 
and urethra. He had pain externally in the genitals on one side, and he traced 
the pain very definitely along the peripheral branch of the pudic nerve, along the 
ramus of the pubis and ischium, to the genitals. Hilton traced the nerve care- 
fully back and discovered at the tuberosity of the ischium on the side affected 
a thickening of the tendons. The gentleman had been used to sitting upon a 
hard uneven seat, and gradually there had formed a thickening of the tissues, 
whicn had impinged upon the nerves and caused this pain. As you know, 
there is a bursa over the tuberosity of the ischum for its protection, and irrita- 
tion or excessive use, or sitting upon a hard seat, or weight unevenly distributed, 
will cause similar troubles. It may be that an Osteopath would go back to the 
spine, but if he did not find a lesion there, the next best thing would be to go to 
the nerve, and see, especially at the tuberiosities. if there was not some trouble. 

II. Landmarks About the Pelvis and Peritoneum. — You are all famil- 
iar with the location of the anterior superior spine of the ilium. It is used by 
surgeons as a point from which to measure the length of the limbs, which you 



170 

know is quite a hard thing to do successfully, so many things make changes in 
the length of the leg. Holden, however, says he finds it more reliable to take a 
tape line and have the patient hold it between his teeth, then measure a fixed 
point on the limb somewhere, (he measures to the inner malleolus) not swinging 
the tape from one side to the other, but making an independent measurement 
each time. You will find that in work upon the pelvis, and in examining the 
legs you will have to see that the patient lies perfectly straight upon the table. 
One good way is to assertain whether or not a line drawn transversely betAveen 
the anterior superior spines is at right angles to the axis of the body ; you will 
have to see that the patient is perfectly straight. It is also helpful in making 
a diagnosis of hip joint disease or disease about the hip joint, to place the thumbs 
firmly upon the spines one upon each, then grasp beneath the trochanters with 
the fingers, and you will be able to examine in that way for two things 5 whether 
the two sides are alike, and at the same time you can press backward upon the 
the spine, a tenderness behind gives evidence of diseases, frequently in the spine 
a tenderness behind gives evidence of disease, frequently in the sacro-iliac syn- 
chondrosis. 

The spine of the pubis is also familiar to you in its location. It is not al- 
ways easy to find ; sometimes you can find it by pushing the lower abdominal 
skin backward towards the direction of the spine ; if not successful then, by ab- 
ducting the limb slightly, causing the abductor longus to be tensed, you can feel 
its attachment to the spine. Frequently it is difficult to distinguished between 
two kinds of hernia, the inguinal and femoral, but it is said that in case of in- 
guinal hernia the spine of the pubis is on the outside of the neck of the sack, 
while in case of femoral hernia it is on the inside. That may be a helpful 
point. 

The perineum has a ligamentous and osseous boundry ; it is bounded by the 
rami of the pubes and ischia, the tuberosities of tne ischia, and the great sacro- 
sciating ligaments, and the tip of the coccyx behind. It is important in our 
practice, I have not seen the point mentioned in books, that we should note the 
shape of the perineum. In the normal, healthy perineum there is a slight 
bowing upward to hold up the pelvic contents. In disease there may be a re- 
laxation of the ligaments of the perineum and a dropping down of the contents, 
causing a bulging of the perineum. Of course the bulging is slight whether it 
is normal or abnormal, but it is important ; those things something cause a great 
deal of trouble, even though the variation from the normal position may be 
slight. In treatmg such a case we go to the pudic nerve where it crosses the 
spine of the ischium, stimulating just where it erosses the spine, and its per- 
ineal branches running to the perineum cause a contraction; also by stimula- 
ting the lower sacral nerves, causing a contraction of the coccygeus muscle we 
thus help it to raise the bowel and the pelvic contents. 

Usually along the region of tlie sacrum we lind the posterior superior 



171 

spines of the ilia. Tiiey are on a line which would pass horizontally through 
the second sacral spine and they also mark the middle point of the sacro-iliac 
synchondrosis. We can find opposite them the spines of the sacrum, down to 
the last, and the two tubercles upon the last just where it ends. The third sa- 
cral spine it is said is the limit of the extent of the membranes of the cord in 
the spinal canal and of the presence of the the cerebro-spmal fluid in the canal. 

The prominence of the gluteti muscles often become significant. That is, 
it is said that in persons of ill health these muscles become relaxed and flaccid, 
and that wasting upon one side is an early symptom of hip-joint disease, which 
is very diflacult to diagnose. The fold of the buttock is the name given to the 
line just below the edge of the gluteus maximus muscle, between it and the up- 
per back part of the thigh, and it is said that in this fold is the easiest place to 
bring pressure upon the great sciatic nerve. Taking a point between the tro- 
chanter and the tuberosity of the ischium, and press in deeply, rather nearer 
the tuberosity than the trochanter, you can impinge upon the nerve. Often a 
person sitting sidewise will have the leg become numb because of impingement 
upon the nerve ; you may sit upon the edge of a bench and injure this nerve so 
so as to cause sciatica. 

A line drawn from the posterior superior spine of the ischium to the top 
of the trochanter, when the thigh is rotated forward, marks at the junction of 
the upper with the middle two-thirds, the emergence of the gluteal artery from 
the great sacro-sciatic notch, and it is at that point that you can determine the 
top of the notch. The pudic nerve and artery, as you know, both cross the 
spine of the ischium. This is located by drawing a line from the same point, 
the posterior superior spine of the ischium, to the outer side of the tuberosity 
of the ischmm, then taking the junction of its outer and middle third, you have 
where this vessel crosses the spine, and there you can impinge upon it. Of 
course the nerve accompanies the artery, and that is an importatant point to the 
Osteopath, for there you can stimulate that .nerve and cause contraction of the 
perineum. The point is mentioned that modern methods of sitting, enjoying 
one's self in an easy chair, or upon soft cushions and the like, causes the parts 
to be supported more by the soft parts about the hips, so that pressure could 
thus be brought upon these blood vessels, especially the pudic, and that a hard 
chair is much more healthful. Upon the condition of these nerves depends the 
blood supply to the interior pelvic organs. Pressure, brought by sitting, upon 
these vessels determines the flow of blood into the pelvis and is a fruitful 
source of uterine and pelvic disorders. 

III. Examination and Treatment of Abdominal Contents — (Con- 
tinued) — As to how to diagnose troubles of the intestine, you will learn that 
better in symptomatology, when you come to the special diseases. However, 
I can show you something of the methods employed. It is obvious that when 
vou have a case of constipation, diarrhoea, flux, or anything of that kind, where 



J 



172 

tbe trouble is. The nerve supply for the intestine, as you know, is through 
the sympathetics from the upper dorsal down ; tbat is, from the third dorsal 
down, because we get the vaso-motors to the mesenteric vessels from the 
splanchnics, and we reach the sympathetic connection all the way down the 
spine. I have already shown you how to treat those parts. We also reach it 
by working on the solar plexus, and you can get an immediate effect by work- 
ing upon the centers either side of the umbilicus. In all these ways we may 
reach the intestine. Stimulation of the sympathetics will inhibit the vermicular 
motion of the bowels, while stimulation of the pneumogastric will increase the 
motion. Of course you know that in working upon the region of the intes- 
tines we also work upon Auerbach's and Meissner's plexuses. There is a 
treatment that we use sometimes m case of constipation, trouble with the 
bowels, that is, we begin at the left iliac fossa, and by deep pressure over the 
line of the colon, work gradually upward along the left lumbar region where 
the intestine runs over the kidney, then across just above the umbilicus, and 
down the right lumbar region; that is,: we work there largely for mechanical 
effect; to soften the fecal matter and work it outward as we go, beginning near 
the orifice. Of course it is impossible not to impinge upon the nerve plexuses 
and not to influence Auerbach's and Meissner's plexuses in working upon the 
intestines there. You will very frequently, according to the season of the 
year, which will soon be upon us, come across cases of cramps and diarrhea. 
It is not, however, limited to particular seasons of the year, I have found 
cases of bad cramps in the abdominal contents where it was almost periodic, 
you might say; it came on every two or three months; after some indiscretion, 
as over eating or eating of too rich food the patient would have those attacks. 
The spasm, as near as I could make out, is most liable to occur in the trans- 
verse colon; it starts there first and there is an irritation, from that point the 
irritation will pass down through the bowel, and the next morning or the sec- 
ond morning you will have tenderness and pain down in the region of the 
right iliac fossa. It has been my experience that it takes that course; and 
from there it will spread over the bowel and you will have a case similar to 
to an inflammation. I think it is an inflammation, from the fact that the pa- 
tient usually passes mucous upon convalescence. This trouble can bo very 
readily stopped. It is done by inhibiting the sp>lanchnics; you can have the 
patient sit upon a chair and hold closely all along the region of the splanch- 
nics, just by a deep pressure, hold at each x>oint for a minute or two and you 
will be able in that w^ay to stop the spasm. 1 have seen it disappear in a 
very short time. The same thing can of course be done by ]>lacing one knee 
along the splanchnics and drawing th(^ arms up and back. Of course i hat 
brings deep pressure, and very forcible, against the splanchnics and inhibits 
them. Particularly it is the upper splanchnics we wish to reach, but it iloes 
no harm to w^ork on down the sphie. It is not a bad idea to ado]>t this twist 



173 

ing motion, because if there is a tightening and irritation of those nerves, you 
will be able to relax them in that way, and I have been able to in that way 
get very good results with such trouble. There is another thing that comes 
to us very commonly, and that is flux and diarrhea. The center for the 
bowels in such cases it is said in opposite the lower two ribs on each side, 
and I do not know what the control is there, but we work by inhibiting, by 
getting deep i)ressure, just as I have shown you. Have the patient sitting 
up, and you can place your knee against the eleventh and twelfth ribs and 
pull the arms up and back, and then against the other side; you can thus in- 
hibit the peristalsis. It is undoubtedly through the sympathetic connection 
there and inhibition of the sympathetics. I never omit in such cases to 
spring the spine, and to spring it strongly; that is one of the cases where we 
have to give a strong treatment, so I have the patient on the side, reach under 
the spine and spring the column up toward me strongly, all along the lumbar 
region. It is very helpful also to adopt this method in such cases: with the 
patient upon his side, have the thighs bent up and get a good hold against 
the sacro-iliac articulation, and spring enough to raise the patient from the 
table. I think you can see from the motions I have given you about what 
you can do in such cases. Also in such cases never forget to work upon the 
liver, I have already shown you how to reach that, and influence it, especially 
the flow of the bile. It does not make much difference whether the patient is 
constipated or whether he has flux or diarrhea, the presence of bile in the in- 
testine is undoubtedly helpful. In cases of constipation the ''Old Doctor" 
says the bile is nature's aperient, and that it helps to stimulate the peristalsis. 
In the other case the action of the bile in the intestine seems to be such as to 
allay the irritation or the inflammation. It simply amounts to restoring the 
normal, in one case you have a lack of bile, and the normal action of the bowel 
seems to be dependent upon it for stimulation. In the other case you must 
work to cause a flow of bile also. Just why it works differently it is very 
hard to explain, unless, as I say, it is the normal condition of the bowel to 
have the bile present at certain intervals, and if that bile is lacking, you may 
have various effects. I had a very interesting case not long since, a gentle- 
man who some years ago, I think about three, had a case of bowel trouble, 
diarrhea and considerable trouble at that time, severe trouble. Since then he 
had had pain after eating, say about three hours after a meal, also bloody flux 
at stool. This had been troubling him off and on ever since he had the old 
trouble. Upon examination the only difficulty that I could find was tighten- 
ing along the lower lumbar region, making a smooth place in the spine, 
which I have already described to you. Besides that the eleventh and 
twelfth ribs on each side were approximated, forced together, so that you 
could feel but very little interspace between them. In the first treatment I 
did all I could to spring the lower part of the spine and to relax the tissues 



174 

in that region, and also adopted motions already shown to separate the 
eleventh and . twelfth ribs. After that treatment the pain after eating ceased 
and he did not have any return of it. The next treatment was given about a 
week later and I repeated the same process at that time, and since then, at 
the last information about a week ago, he had had no return of the trouble, 
and that was about two weeks after the treatment, ^ow, that was all very 
simple, it was merely looking to see where things had departed from the nor- 
mal, and restoring them and relieving the tension upon the parts. One thing 
that I did in that case was to relax the ligaments in this way, by springing 
the lumbar region, and working the limbs first up in that way and then down. 
You will learn these motions and how to apply them. It seems that in some 
certain kinds of trouble one motion is more efficatious than another, and you 
will also find that it varies with your patient. I also in that case took what 
I call the quarter turn to relax the tension between those ribs. That is, I got 
the legs of the patient in my arms, and turned him until his body was about 
three quarters off the table, then let him slip down and around back on to the 
table in that way, straightening the legs. I think you understand, as I 
showed you the motion before. I think I mentioned the point that a displaced 
coccyx is sometimes the cause of diarrhea. There is also another important 
treatment in the case of intestinal troubles. That is, you may raise the intes- 
tines almost bodily, especially in cases where there is a relaxation of the ab- 
dominal walls, where yuu find the transverse colon descended below the um- 
bilicus, and then by pushing in deeply above the pubes you can push upward 
and outward and thus raise the abdominal contents. Another motion is to have 
the patient lie on the side and then to reach deeply into the fossae and work in 
on the right side under the caecum, follow it up and spread apart, and then 
work in the same way on the left to raise and spread out the sigmoid flexure. 
That is frequently a very ejood way in which to treat troubles of the intestine, 
especially where you expect any sort of relaxation allowing the bowel to drop in 
that way, and that is in almost every case where you have had intestinal 
trouble that has been going on for some time, there is almost always a relaxa- 
tion of those ligaments and prolapse of the bowel. You will remember that 
the defecation center is at the second lumbar, and the '"Old Doctor'' has shown 
me a good point in how to reach the second lumbar. He places the thumb of 
one hand just over the trochanter or just above, and then finds the second lum- 
bar by counting carefully up from the fifth lumbar, and then while he presses 
upward the trochanter of the patient with the hand that is on the hi{), he pre>*ses 
inward with the other hand and gives a turn to the second lumbar. Then tak- 
ing the same point for one hand, and reaching undor and raising the [patient's 
head and shoulders you can thus very effectually relax the secoml lundnir. 
You see that makes the second lumbar a fixed [^oint and you swing the upper 
part of the trunk around it. and in the other plaeo you swing it in nuu'ii the 



175 

same way. Robinson makes quite a point of the fact that what he calls the fe- 
cal reservoir, viz., the left half of the transverse colon and the descending 
colon and the sigmoid flexure, are all supplied by the inferior mesenteric 
ganglion. This inferior mesenteric ganglion is found on the inferior mesen- 
teric artery, and you can reach it by working a little toward the left about two 
inches below the umbilicus. We have very good results in cases of constipa- 
tion by working in there with such motions as this, and this stimulates that 
plexus; the inferior mesenteric ganglion of the sympathetic. In speaking of 
the use of bile it is not only helpful in cases of diarrhea, flux and constipation, 
but that is our way of destroying entozoa, tape worms or seat worms or para. 
sites of any kind, it is said it is always beneficial to stimulate the flow of bile in 
such cases, and very frequently that is all that is necessary, thus causing the 
worm or whatever it is to be acted upon by the bile. In treatment of con- 
stipation you will frequently find that the patient is simply in trouble because 
he has not drank enough water, and that is why very frequently it is necessary 
to prescribe so many glasses of water in a day, you can say mineral water or 
spring water, or something of that kind, so they will think you are particular 
about it. It is said that the explanation of why drinking of water is beneficial 
in cases of constipation, is that when the stomach is empty, the water should 
be used one half hour before breakfast, that the water passes into the intestine 
and is easily absorbed by the lacteals and carried to the portal circulation, and 
that stimulates the flow of bile and increases its quantity, and thus it affects the 
fecal contents. 

As to the treatment of the spleen, I have already shown you that at the last 
lecture. You will find that there is a tenderness along the spine behind, and 
in front along the region of the ninth, tenth and eleventh ribs on the left side 
in such cases, and Dr. Harry Still tells me that in such cases it has been his ex- 
perience to find a cold, clammy perspiration, especially on the left side of the 
body. What we do there 1 have already explained, raise the ninth, tenth and 
eleventh ribs, and work carefully under the tips of the lower ribs in front. As 
I explained at the last lecture, the vaso-motor supply of the spleen is not un- 
derstood, but it was stated that we changed its size by work upon the peripheral 
terminals of the splanchnics, but it is understood also that there is a center in 
the medulla, there is also a center in the medulla for the intestines and it seems 
that some trouble with the atlas, or some tightening of the ligaments may im- 
pinge upon the sympathetics and thus get an effect either through the medulla 
or directly through the sympathetic system. 



LECTUEE XXYI. 

At the last lecture I was following the subject of examination and treat- 
ment of the abdominal contents. I shall pursue that subject farther to-day. 



176 

taking up also the pelvis, its examination and treatment, particularly with re- 
gards to slips or twists of the pelvis as a whole and of the innominate bones. 
We had gotten as far as to the kidneys. To treat the subject in a general way 
we can only say that in general where there is trouble with the kidneys there is 
a tenderness in the back, freequently contractures or displacements along the 
spine. There are general symptoms which you will learn to recognize, and 
which you will find by urinalysis, which you have learned elsewhere. Also such 
things as odor of the breath, and condition of the tongue, it is said that a fur- 
rowed or ridged tongue indicates kidney disease. The complexion, and various 
things of that kind, are indications of kidney disease ; also fever, especially fol- 
lowing suppression of the urine, since then the system is poisoned. Often 
you have painful micturition due to bladder or kidney disease, and so on. The 
chief thing, however, is how we, as Osteopaths, treat the kidney. The nerve 
supply is largely through the renal splanchnics, the last splanchnic rising oppo- 
site the twelfth dorsal. I have already shown you how we should work there. 
Also the second lumbar is the center for micturition, and the effect that we get 
by working upon the second lumbar is probably a vaso-motor effect, since you 
know that vaso-motors leave the spine all the way down, especially from the 
sixth dorsal to the second lumbar, having both vaso-dilators and vaso-constric- 
tors within those limits. A lesion at the atlas also effects the kidneys, probably 
by an effect upon the renal center in the medulla. Hence, we always examine 
to find whether or not the atlas is displaced, and if not, we are able to get an ef- 
fect upon the renal center in the medulla by working on the superior ganglion 
and in the sub-occipital fossa. Hence, we get a sympathetic effect. Now, a 
lesion in the cervical region, especially at the upper part, at the atlas, ma}' affect 
the kidney directly through the sympathetics, and indirectly through the center 
in the medulla. 

One of the best ways to treat the kidneys is the method employed bv Dr. 
Harry Still; have the patient upon the back, with the knees raised, you then 
have all the muscles relaxed. Then by lifting along in the region of the 
lower splanchnics, simply raising the patient upon the fingers and springing 
outward as you go, you relax the contractions, and spring the ligaments and 
get a general stimulating effect upon the kidneys. You will find that, I think. 
one ot the best treatments. Another tieatmeut is to press here at the umbilicus, 
and by pressing deeply, spreading and stimulating probably the sympathetic 
ganglia upon the renal vessel, as there the renal ganglia occur. Also the cen- 
ters which I have before mentioned, occuring one on either side of the umbilicus 
in the skin, called perintoneal centers, have an effect upon the kidneys, and 1 
do not doubt but that we get some tiovt of a mechanical effect also in this way. 
by relieving any pressure which may be brought upon the renal vessels. Oi 
course there are other things that may bring mechanical pressure upon tlio renal 
vessels, such as aneurism of the abdominal aorta, an enlarirement of sonic one of 



the aneurism of the abdominal aorta, an enlargement of some of the abdominal 
organs, or tumors, and in those cases yoa must direct vour treament to the con- 
ditions which are producing the disease. You will frequently come across cases 
of renal colic, that is, stone in the kidney or in the bladder, and in the passage 
of the stone down the ureter the pain is excruciating. Renal cohc is the name 
given to the pain caused by the passage of the stone. Of course the deposit 
varies, sometimes the stone is large, and it varies in composition. I do not 
need to go into that, as that is not the purpose of this lecture ; sometimes it is 
a crystal of uric acid about which deposits aggregate, and in the long run there 
is quite a large stone. As to the proper treatment for it, when a stone is started 
from the pelvis of the kidney down the ureter, it is our treatment to work along 
the course of the ureter and to work it back, if it is possible, because you can 
diso?ve it as w^ell in the kidney as you can if you press it on down to the blad- 
der. Of course if it has started on down the ureter and can not be worked 
back, it should be worked on down into the bladder. Y u know what the 
course of the ureter is, from about the level of the umbilicus, a couple of inches 
on each side, down obHquely to the base of the bladder. Of course I do not 
mean to say that you can feel the uterer by working along its course. You can 
however, bring aeep pressure along its course, and thus work upward any stone 
which may be m it. That is frequently done. In such cases our treatment 
would be directed to stimulating the general health of the kidneys, that is, to 
mciease its healthy action, sc that these stones could not be formed. If your 
kidney is acting properly you will not have renal calculus. Not only would 
we take care of the renal splanchnics, and the second lumbar, but all along the 
lumbar and lower dorsal region. I have tried to teach you that your lesion may 
be at the center, but it may be above or below, causing trouble with the kid- 
neys. In general our success with kidney troubles has been very good. Of 
course when you come to general treatment, drinking of hot water, bathing, 
and exercises, are all good. There are some who believe that it is beneficial to, 
as they call it, flush the kidney every morning by taking a drink of water be- 
fore breakfast. That acts upon the kidneys as well as the bowel. It is proba- 
ble that the increased excretion would tend to keep the kidneys flushed. Bj^ron 
Robinson notes that fact, but does not give it the weight of his authority. 

As to examination and treatment of the pelvis, when you come to its con- 
tents the books have a great deal to say, but as to the pelvis as a whole slipping 
or becoming twisted, I have not seen a word about that in any books. How- 
ever, that is an important thing in our work. The pelvis or the innominate 
bone may be slipped m different directions, and the correction of these slips 
gives the Osteopath very gratifying results indeed. The whole pelvis may be 
slipped forward or it may be tipped backward in the first place, or the whole 
pelvis may be twisted from side to side, and you would have tenderness on each 
side at the sacro-iliac synchondrosis particularly, and j^ou would also have ten- 



178 

derness at the symphysis, for the reason that the sacrum is broader in front, as 
you see, and movement of the parts then would tend to cause the wed^e-shaped 
sacrum to act upon the innominate bone and press them apart, thus you would 
have a strain at the symphysis, and you would have tenderness here just at the 
symphysis. In examining for these troubles, always pay attention to the 
symphysis. You would always have tenderness where the ligaments bind the 
back part of the sacrum to the innominate bones. If it is tilted backward, 
your hand when it has become able by touch to detect the departure from the 
normal, will find that the posterior portions of the crests of the ilia are project- 
ing farther back, and when tilted forward, that the posterior portions of the 
crests are tilted farther forward, so that you will come to find out whether the 
position is correct when you examine by palpitation, which is our general 
method. Now, if the pelvis is twisted from side to side you would find a tender- 
ness on each side, at the sacro-iliac articulation as well as a tenderness in front, 
at the symphysis and you will have to judge which is the case. Of course if 
the pelvis is twisted you can by examinaing the back get an indication of 
which way it is twisted. It will take very close work in examination and 
you have to give it your careful attention. The reason why you would have ten- 
derness on each side is tnat in a twist of the pelvis from side to side you would 
have both ligaments thrown on a strain, one diagonally backward, and one di- 
agonally forward, and you would get tenderness in each case. When you have 
these slips and twists, of course you have something then that is affecting the 
sacral plexus of nerves, and the result maybe pain down the legs, and you may 
have sciatica in one or both limbs, and the most fruitful source of pelvic disor- 
ders, especially of female troubles, is a slip of the innominate, as you will see 
later. So your examination, then, would include both the symphysis in front, 
and the articulations behind, coupled with an examination for general disorders 
of the pelvis and even down into the limbs. 

Now, as to how to treat the pelvis if it is tilted forward. One of the best 
ways that I know of is to set the patient on a chair, and then by putting the 
knee in the sacrum behind, we can reach in front and get hold of the anterior 
superior spines and pull backwards; it does not take a great deal of force. 
and at the time it is quite a good movement to pull the patient forward. If the 
pelvis is twisted, of course then the lower part of the body in respect to the 
waist is turned to one side or the other. One of the best ways to fix that is 
to set the patient on a chair and get the arms up over your shoulder, you can 
sit right down on their knees, and give a twist to one side ov the other, sim- 
ply making an effort to move the whole trunk of the body upon the articula- 
tion with the pelvis, and as that is rather a moveable point, and often the 
point of displacement, you can readily turn it from side to side. You can 
also move the whole X)elvis forward by some such niolion as this: have the 
patient lying ujion his side, you can make a lixed [)oint with one hand against 



179 

the back of the sacrum, and you can pull the limbs backward in this way; 
that would be when the pelvis was tilted backward. Or, you can get the 
knee in the back, and pull back on one side and then on the other with the 
patient lying upon his side as well as to set him in the chair. Some will pre- 
fer that method perhaps. Then, there is another method; of course there are 
different ways in which you might do this. One of the best ways which I 
have found to move the pelvis with the patient on his back, is to fix the hand 
and place it under the sacro-iliac articulation and then flex the thigh, and pull 
the knee down, out and around quite strongly and thus relax the ligaments of 
the articulation. That should be done upon one side and then upon the 
other. Our experience and practice has taught us this one thing: that liga- 
ments are extremely important, the ''Old Doctor" sets considerable store by 
ligaments. You may have such a thing as a cold, and the effect upon the 
ligaments will be to contract them, and you will have dislocations of the parts 
affected, from that simple fact. You may have dislocations of the pelvis or 
of one of the innominate bones. I had quite a remarkable case the other 
day — there was almost complete paralysis of the lower limbs, there was sen- 
sation and some motion, but there was very little motion, the patient went 
about in a chair. That had all been brought on by la grippe, and the whole 
body had ceased to grow, the arms were thin and small, the face and head 
were normal, and you got the impression of looking at a dwarf when you ex- 
amined the patient. So it is that a cold, light or severe, may act upon the 
ligaments and contract them and cause displacement of the parts, and there 
is no doubt that is frequently the cause of displacements of the pelvis, as of 
other parts. Now, I have already stated that not only may the whole pelvis 
move one way or the other, but one bone may move one way or the other. 
That is, the whole bone may be slipped up or down or it may be tilted back- 
ward or forward. However, when the bone is tilted forward, you will see 
that it almost inevitably goes somewhat upward on account of the shape of 
the articulation here with the sacrum. From that fact, since when it is tilted 
somewhat forward, and at the same time has a tendency to slip up along the 
back part of the articulation, it will have the effect of shortening the leg. 
Consequently, when the innominate, not the pelvis as a whole, is slipped for- 
ward you might have a shortening of the leg. Naturally you would suppose 
that a slipping forward of the pelvis would lengthen the leg, but you can see 
from what I have said that such is not likely to be the fact. Of course that 
would change the normal axis of the parts. The various axes are made by 
junction of the sacrum and ilium by means of ligaments, and when the in- 
nominate bone is moved in one direction one point will be fixed and act as an 
axis, and another point will be fixed and act as an axis in another position of 
the innominate bone. That subject has not been thoroughly studied out, but 
it is a fact that when the innominate is slipped forward then you have a 



18(1 

shortened leg, and when backward you will probably have a lengthened leg. 
Dr. Harry is authority for the statement that a twisted or tilted innominate 
may shorten a leg as much as three inches. Of course a novice looking at 
such a condition would think at once that the hip was dislocated, and that he 
had one of those wonderful things that are so much talked of, but it is not 
always the case, and you must be careful in your examination. One of the 
first things in examination is to make these motions of the thigh in and out, 
flexion of the knee up toward the shoulder, and so on, for the purpose of re- 
laxing all the unnatural tension about the leg, so that you can tell whether or 
not the limbs are similar. Then, getting the patient straight upon the table 
which you will have to do by accuracy of your eye, you can of course judge 
whether or not a line drawn between the anterior superior spines is at right 
angles to the direction of the body. Then you will, by taking a certain point, 
preferably the bottom of the heels, or just where the seam runs around above 
the heel, note whether the legs are of the same length. Of course you will 
have to take into consideration any variation in the thickness of the heel, 
some people have a thickened heel or sole put on their shoes for the very 
reason that their limb is a little shorter, though quite as frequently the con- 
dition has not been discovered. When you have pain in the lumbar region 
of the back, pain in the hip, or in the leg, or in the sacral region, or in the 
external genitals, you will do well to examine to see whether or not the limbs 
are of the same length, and if such is not the case you may continue the ex- 
amination further by looking to see whether or not the pelvis or one of the 
innominates is displaced. When you come to measure one leg by the other 
you have a variable standard, it is hard to tell whether or not one leg is 
longer than it ought to be, or shorter. So you have to take means of detei'- 
mining which is the affected side. It is well to go to the sacral articulations, 
where there will be soreness on the side affected, because a greater strain has 
come upon the ligaments there, and you will also have a soreness on the sym- 
physis on the side affected. You will frequently have a tension and some 
tenderness, very likely from contraction of muscles, on the opposite side from 
the one affected. Taking this left one as the one affected, then you might 
have a contracture here and some tenderness on the right side, because when 
you have one thrown out of 5)Osition, then you have the equilibrium de- 
stroyed; there has to be readjustment of the parts, and you will have tension 
there on that account, but T think the rule given you will indicate to you 
which is the side affected. 

As to how we may remedy the defect of one innominate bei,ng slipped, 
there are various ways ; some are the same as I have shown you. As T liave 
said, the motion thus employed, by tlexing the thigh against the thorax, phu'- 
ing the hand firmly under the pelvis, and pushing the knee outward and dinvu, 
thus straightening the leg again, is one of the best methods 1 have found. After 



181 

you have done that, it is just as well to give the leg a straight pull, not a jerk, 
and you can thus bring tension upon the ligaments, and you can in that way 
frequently straighten mechanically, and I think you can get a certam nervous 
effect that will relax the spasm. It is just like putting your hand upon a con- 
tracture and gently pulling against the contracture until you have relaxed it, 
so it is with the limb, you can relax the spasm of the muscles, you can restore 
the equihbrium of nerve force, and it will return to normal. That is one way; 
another way is for the operator to stand in front with the patient upon the side, 
then, by reaching under the limb and grasping the tuberosity below and the an- 
terior superior spine above, you can move it in either way very readily ; you 
can slip the innominate forward or backward ; that is one of the best ways. 
You can in that way stand in front of your patient and do your work. You can 
get behind the patient, use the knee as a fixed point against the sacrum, and 
then, holding against the anterior superior spine, work it backward in that 
way. When you stand behind, the idea is that you can work to draw the an- 
terior spine toward you. Also you can stand behind the patient, one arm be- 
neath the thigh of the patient, making a fixed point of your hand against the 
sacrum, then bend the leg back until you have it back tc a considerable ex- 
tent, varying the degree of tension according to the patient. That is one very 
good way to force the bone forward. Pressure upon the sacrum is very fre- 
quently employed; it is one of Dr. Hildreth's very common treatments. In a 
great many cases of treatment along the lower part of the spine Dr. Hildreth 
will finish by putting his knee against the sacrum and bringing it inward 
against the patient, while he draws the pelvis of the patient back towards him. 
The idea being, as you readily see, to relax the hgaments and to take off the 
tension which is thus brought upon the branches of the sacral plexus. From 
what I have said and from combinations that your own ingenuity will suggest 
to you, you can remedy the defect when the innominate is slipped upward or 
downward. You might set the patient upon a chair and lift upward, at the 
same time having an assistant push downward upon the crest of the innominate 
affected. One point that you might notice in regard to affecting the innomi- 
nate is the fact that the quadratus lumborum has a tendency to help matters 
along by its contracture, and in relaxing the tension about the innominates 
when displaced, you would do well to stretch the quadratus lumborum. That 
I have shown before ; give it the diagonal stretch this way once or twice and 
once or twice the other way ; you can do that better with an assistant, because 
you can get a better tension. I think this shows the value of steady, firm work 
over the body. The idea of working with jerks is bad, because as a rule, when 
you give a pull or a pressure, the idea is that you are relaxing, it is in the 
nature of inhibition of nerve force, and if you go at it with a jerk, you are not 
only liable to stimulate instead of inhibit, but thus set up a firmer contraction, 
whereas vou wish to relax. 



182 

In treating the pelvis, I have already noted the point that you can work 
upon the spine of the ischium, thus impinging directly upon the pudic nerve. 
I have indicated how you should find that point by a line drawn from the pos- 
terior spine of the ilium to the outer side of the tuberosity, the junction of the 
lower with the middle third of the line will be the point where you can best 
impinge upon the pudic nerve, and then by relaxing the glutei muscles by draw- 
ing the limb backward some, you can get deep pressure at that point, and thus 
stimulate or bring pressure and inhibition upon the nerve. Of course the effect 
of that is to work upon the perineal branches, and through it to cause contrac- 
tion of the perineum itself. 

As to the bladder, the point at which we reach the hypogastric plexus, sup- 
plying the fundus of the bladder, is at the fifth lumbar, as you well know. And 
then along the sacral region we get some motor fibers to the bladder. Along 
the lumbar region, according to Quin, we get motor fibers, particularly to the 
circular fibers of the bladder, including the sphincter. He says there are prob- 
ably also to aid those fibers, inhibitors to the longitudinal fibers. Thus, work 
along the lumbar region would affect the bladder. An inhibitory effect would 
be to relax those circular fibers, and a stimulating effect would be to contract 
the circular fibers. In the sacral region the Osteopath takes as his center, the 
third and fourth sacral, and he works there to relax the spincter of the blad- 
der. It is stated by Howell's Text Book that in that region we get principally 
the nerve fibers to the longitudinal muscular fibers. So you see there is a con- 
tradiction between the Osteopath and the text book. However, it has been our 
practice that by working in that region we got the effect, and of course when 
theory and practice conflict we must take practice. There is a difference be- 
tween the text book and what we have found in practice ; we cannot always 
make them agree. It is stated by Howell's Text Book that in the sacral region 
and in the lumbar region there are no vaso-motor fibers given off to the blood 
vessels of the bladder. 

It is hardly worth while to tell you how to examine the bladder. Of course 
you know where the bladder is situated : when distended, it will rise above the 
pubes, and vou will likely find it by the tumor, and on percussion you will get 
the flat sound from the contained fluid, so that will be part of your examina- 
tion, but the general symptoms which you will get, particularly in your symp- 
tomatology and in urinalysis, will direct you in your examination of the blad- 
der. If you have a case of ammoniacal urine you will be able to recognizt^ 
the crystals under the glass, and can tell whether there is trouble with the 
bladder in that way, you will note the presence of bacteria, setting up a de- 
composition in the urine. Several months ago I examined a sample of urine 
under the glass; it was freshly drawn and it was crowded with bacteria. I 
directed the operator who brought the sample to boil the bottle anii let it cool 
and thus have it completely sterilized, and biing me a sample as fresh as 



183 

possible. He did so, and examination showed a great number of bacteria, 
and that very soon after obtaining the urine. This indicated the presence of 
bacteria in the bladder, setting up a decomposition of the urine. In that in- 
stance it was a case of bladder instead of kidney trouble, as had been thought. 
That case had an enlarged prostate; the prostate had acted as a partial strict- 
ure to the passage of urine, and the patient had used a catheter, had not taken 
any precaution to keep it antiseptic, and had thus brought about a large 
amount of his trouble. The operator washed out the bladder with some anti- 
septic solution and reduced the prostate, and the patient was out in a few 
days. The doctors had had him ready to die of kidney trouble, but the trouble 
was all in the bladder and prostate. Of course in all our treatments we get 
particularly an effect upon the centers indicated in the spine, viz.: the fifth 
lumbar and the second lumbar, the centers respectively for the hypogastric 
plexus and micturition. The treatment there I hardly need to show you: it 
is the same as I have already shown you in how to treat the spine. There is 
another treatment, though, which I have already shown you, the treatment 
by raising the bladder bodily. You can do the same thing by having the 
patient stand in front of you, bending forward at right angle, thus letting the 
abdominal contents drop down toward the symphysis, then by deep pressure 
inward and raising as the patient straightens up, you can raise all those parts. 
I have spoken already of enteroptosis, the dropping down of the intestine ; I 
shall speak presently of the prolapsus of the uterus and all those things that 
allow a lengthening and a relaxation of the ligaments which bind these abdom- 
inal contents to the walls. Anything which allows a relaxation, of course 
brings down those structures, and the Osteopath argues that there is too little 
life there. Now, how does he go about to replace those things! Should he 
simply push them into place, they would not stay — they must be held there. 
Hence, the importance of our work along the spine, stimulatmg the nerve force 
and life to the omenta which are holding these abdominal contents in place, so 
as to regain their tonicity. Never forget that it will not do to replace a pro- 
lapsed uterus or replace intestines which are displaced by reason of enterotosis, 
unless at the same time you include the work along the spine ; that we work 
with the idea of stimulating the life of the ligaments and making them tense 
again. In fact, we should always have that in view, particularly we should be 
careful to stimulate or inhibit the nerve force to the part in trouble. We would 
also work deeply in this manner here over the internal iliacs. That is one of 
the treatments for the bladder also. We thus stimulate the blood supply and 
direct it more particularly to the part affected, by reason of the tendency tow- 
ard the normal, and that treatment is very effective in such troubles. Of course 
in retention of urine you will always suspect some stricture. You may have 
an enlargement of the prostate or some trouble of the sphincter of the bladder. 
You will find also that the quantity of urine varies — after very long reading by 



174 

a person who is not used to reading much, the amount of urine will be in- 
creased, and after hysteria and various troubles, the amount of urine is greatly 
increased. There is a motion employed largely by Mrs. Patterson for raising 
both the bladder and the uterus. She has the patient flex the thighs, then, 
directing the patient to hold the knees together, you push them apart. In other 
words, you work against the resistance of the flexed thighs. In that way the 
psoas muscles will contract and the idea is that as you push them out the blad- 
der will be raised ; haying done that you try just the opposite and tell the 
patient to hold the knees apart and you draw them together. Mrs. Patterson 
employs that method of treatment very frequently and has had very good suc- 
cess in female troubles in that way. It affects both the bladder and uterus. 

We should next direct our attention to the ovaries. They are found an 
inch and a half inward from the anterior superior spines of the ilia. It is said 
they cannot be examined by physical means, that is, you cannot find them by 
simply feeling over the flesh where they should be, and it is only when tender 
or when enlarged that you will be able to make out by physical examination 
the location of the ovaries. However, when inflamed, as they very frequently 
are, the intense tenderness there about an inch and a half interior to the anter- 
ior superior spine would indicate their site. Also when inflamed they frequent- 
ly cause a swelling there and you will be able to find their location. The ovary 
is also frequently the seat of a tumor, and the tumor may become very large, 
and then not only palpation, but inspection,- will reveal the seat of the trouble. 
Our treatment for the ovaries is through the lumbar region, as you know. The 
centers given by Howell's Text Book for the internal genitals are along the 
lumbar region from the second to the fifth ; that is, vaso-motor fibers of both 
kinds run to the internal genital organs. We should also examine carefully 
the sacro- iliac region and the lower dorsal. The center for the blood supply 
for the ovary is between the tenth and eleventh dorsal, and you should look all 
the way from the ninth to the twelfth dorsal particularly to see whether or not 
there is a lesion affecting the ovaries. We work upon the eleventh dorsal, re- 
storing it to normal when it has been misplaced, both in cases of profuse men- 
struation and in scant menstrual flow. That seems to be the particular center 
since it has control of the blood supply to the ovary. Also, as you know, the 
spermatic artery in the male, becoming the ovarian in the female, arises about 
opposite the second lumbar vertebra, that is, a little above the umbilicus, and 
by working in deeply, trying to get as far as possible in under the transverse 
colon and working on down in the direction of that artery, down as far as the 
ovary, you will be able to stimulate the blood-fiow, and then by working back- 
ward in the same direction you stimulate the venous flow ; also working over the 
utering blood supi)ly, because these vessels anastomose a good deal, and you 
thus stimulate the entire blood supply. Of course the ovaries are closely con- 
cerned with menstruation and it will be worth vour while to bear in mind thai 



185 

they act alternately, one will ovulate one month and then not again until the 
second month. So if you have a trouble recurring every second month you 
will be able to calculate that the trouble is in one ovary or the other, and your 
further examination will indicate to you which is the ovary affected. In cases 
of obesity where the patient is extremely large, cases are on record where the 
accumulation of fat has acted to crowd the ovary, hence the menstrual flow did 
not occur and the ovaries were atrophied. It may act in a mechanical way and 
separate the Fallopian tube from the ovary so that the Fallopian tube cannot 
take up the ovum wnen discharged. So that if you have such a case of men- 
strual trouble where the patient is extremely large and obese, then you will 
bear in mind that the obese condition itself may have some effect in causing 
the trouble. Of course the ovary, as it is situated in the broad ligament, is 
drawn down in any prolapsus of the uterus and will be implicated in many 
troubles of that kind. As for treatment, it is especially along the lumbar re- 
gion and also at the centers designated, the eleventh dorsal, not forgetting the 
fifth lumbar, which is the center for the hypogastric plexus, through which we 
get the pelvic plexuses which have to do with the life of the ovary. 

Q. In that case of paralysis you spoke of caused by the grippe what was 
affected ? 

A. The whole spinal life was affected. I have seen cases where the grippe 
was the only cause apparently and the whole muscular life along the spine was 
diminished. 

Q. Do 3^ou think that can be corrected by treatment? 

A. Yes, sir; I think we can secure good results. 

Q. Does that also include the ligaments along the spine? 

A. Yes, sir ; that is the main trouble. The hgaments are contracted, 
shuttinoj off the nerve force. 



LECTUEE XXVII. 

At the last lecture I spoke of the examination and treatment of the pelvic 
viscera. I shall continue that subject to-day, concluding the examination 
and treatment of the pelvis and its contents, and taking up the osteopathic 
treatment of the limbs; I shall then have gone over the whole body. 

I. Examination and Treatment of the Pelvic Viscera. — Con- 
tinued. — The next organ for us to consider is the uterus. I might say in 
passing that female diseases are among the most numerous class of cases that 
we handle, and are among those best handled by us. A very large per cent 
of your cases will be various female troubles, and you will have very good' 
success with them. The examination of the ovaries I spoke of at the last 
meeting. Xext to the ovaries the uterus is quite as frequently the seat of 
tumors as elsewhere. These may occur in any part of the organ, and when 



18G 

these have enlarged the organ by their growth, you can by the ordinary 
methods of examination iind the trouble. In general, speaking of troubles of 
the uterus, prolapsus is very common, anteversion, retroversion; also ante- 
flexion or retroflexion, the bending of the uterus on itself. When the uterus 
falls, it may fall forward and impinge upon the bladder, and thus one of the 
symptoms will be very frequent micturition. It may fall backward and im- 
pinge upon the rectum, and you will have a mechanical cause of constipation; 
dragging pain in the loins and pain down the limbs. Frequently it is asso- 
ciated with local headache, which is generally on the top of the head; it may 
be on the back of the head or it may run over to the forehead or to one side, 
but its peculiarity seems to be that it becomes a local headache. There are 
other symptoms, since the uterus becoming displaced will impinge upon 
other viscera and the plexuses of those viscera. You will have sympathetic 
troubles, such as vomiting, sick stomach, and things of that kind. In case 
of any displacement of the uterus, the patient is likely to be very sick at the 
menstrual period. At such times the fact that the organ is down and is thus 
stopping the flow of blood will lead to this condition. I have seen very pain- 
ful cases at the period relieved immediately by replacing the uterus. How- 
ever, that is not usually a good plan to pursue at the menstrual period, since 
the organ then is very tender, and any handling is liable to irritate it and set 
up an inflammation or some sort of growth, and you must always be extremely 
careful in local treatments of the uterus. There have been some very re- 
markable cases instanced of an enlarged uterus. Of course the uterus nor- 
mally enlarges within physiological limits; it enlarges also from tumor. The 
chief way in which tumor is differentiated from the normal enlargement of 
pregnancy, is that after a certain time you can hear the uterine souffle and 
the foetal heart beat. Also after the fourth month, sometimes before and 
sometimes later, you will get movements of the uterus. Dr. Smith tells quite 
an amusing story of a lady who came to term, she was perfectly sure that she 
was ready to be delivered, but he found merely gas in the intestines, a pecu- 
liar movement of the gas had simulated the movement of a foetus, which liad 
been taken for quickening, and the gas in every respect simulated pregnancy: 
and so it has been, you will find some remarkable cases. I only sj^eak upon 
these subjects generally, because in gynecology and obstetrics, whicli you 
will take up later elsewhere, they will be treated fully. What T aim to tt^U 
you is how the Osteopath treats the uterus. In examining the uterus, be- 
sides these general symptoms I have given you, a local examination will 
usually remove all doubt. By inserting the finger into the vagina yon can 
feel at the ux^per end of the vagina, the uterus. You know how the uterus 
lies in relation to the passage of the vagina — nearly at right angles, perhaps 
not quite. The normal feeling of the cervix is described by the "Old Uocror" 
to be about like the normal t'eelinii' of the end of the nose, that is, when the 



187 

uterus is normal. On account of the transverse direction of the os you can 
tell whether or not the uterus be fallen or twisted. If you find that the os, 
instead of being directed from side to side, is turned at an angle, you can 
judge from that in which direction the uterus has been twisted. The most 
common displacement is said to be downward and backward and to the left. 
Frequently you will find a sort of a turn associated with this displacement, 
and that the uterus lies down near the left sacro-iliac articulation. If the 
uterus has fallen forward, of course you will find the cervix and the os pro- 
jecting backward, and if it has fallen backward, you will have the cervix and 
OS projecting forward, and you will be able to judge as to its position. That 
is what the Osteopath ascertains in making examination per vaginam — he 
looks to see whether or not the uterus is in normal position. 

Of course you know about the eight ligaments of the uterus; the broad 
ligaments are the most useful. They extend from each side to be attached to 
the pelvis, and when the uterus is displaced to one side you will find a ten- 
derness in the broad ligament on the opposite side, readily explained of 
course as the tension comes ui^on the ligament of the other side, the weight 
coming on it as the uterus falls from it. That is one way in which we diagnose. 
Another point in examination per vaginam is to note the condition of the 
vaginal walls. Of course in prolapsus the walls have lost their tone; they 
have part of the duty of sustaining the weight of the uterus. When they are 
full of tone they will help to hold the uterus up, but if they are prolapsed 
and sunken down they become flaccid. Frequently you can give great relief 
in female troubles by simply passing the finger up along each side, before and 
behind and at each side, and smoothing out these wrinkles which ha^'e gotten 
into the walls of the vagina. You can also by that treatment stimulate the 
flow of blood and stimulate the local nerve force, and thus lead to more life 
in the vagina and consequently to a better performance of its duty of helping 
to hold the uterus up. 

You will find such troubles as leucorrhea following the displacement of 
the uterus, since the nutrition is partly cut off from the walls of the vagina, 
the circulation is impeded and the healthy tone does not exist, consequently 
you have a morbid secretion. 

The normal position of the uterus I suppose is known to you — the broad 
ligament tilts somewhat backward in the pelvis and the uterus is tilted for- 
ward at the upper part of the vaginal passage, so that you have practically 
speaking a right angle between the walls of the vagina and the uterus, per- 
haps not quite a right angle. Of course the uterus normally does not rise 
above the brim of the pelvis. I wish to emphasize in this connection with I 
said the other day in regard to prolapsus of the uterus and of the intestine, 
that is, the Osteopath replaces them, but does not expect them to stay simply 
because he has replaced them. You must always couple local treatment with 



188 

treatment along the spine. I remember a case in point — I examined a young 
lady in Peoria, she had had a twist in the gymnasium, she had jumped to 
catch a cross-bar and had given herself a jerk and a twist. Along in the up- 
per lumbar region there was a lesion, I do not remember now exactly which 
vertebrae were displaced, it was, however, of the lumbar vertebrae, there was 
quite a prominence of one of them. Shortly after the accident the young lady 
was troubled with frequent micturition, and local examination later revealed 
the fact that the uterus was down upon the bladder. That case was treated 
at the front over the abdomen, over the iliacs, and along the spine, particu- 
larly at the second and fifth lumbar centers, through which you can reach the 
uterus. The case was entirely cured in two months, and she had not had 
local treatment more than a half dozen times. So you see the Osteopath does 
not depend upon simple reposition, he depends largely upon the work of 
stimulating the nerve force and toning up the blood supply to give tone to 
these ligaments which have lost their tone, and thus hold the parts in place. 
For the purpose of the Osteopath the finger answers as well as anything for 
an instrument. The first finger is usually inserted, and you can feel the 
cervix of the uterus. The idea then is to push upward in such a way that 
the organ will take the position of being at a right angle to the broad liga- 
ment, and it is as well while your patient is upon the table to insert the fin- 
ger, reach upward to the uterus, then have the patient slip around and stand 
up and you can then push forward. One of the best ways of replacing the 
uterus is to have the patient take the knee-chest position — kneel with the 
chest down upon the table or bed, and then to push the uterus up, and thus 
allow the intestines to fall down behind and over the uterus and hold it in 
place. The ''Old Doctor" has invented an instrument which is very useful 
also in reposition. It is a wire, curved with a handle. The finger of the 
operator is slipped in with the instrument lying in the opening between the 
two wires, and then the point of the instrument is placed either behind or in 
front of the os, depending upon the position of the organ, whether it has 
fallen forward or backward. Then with the point of the instrument back and 
the finger in front, or vice versa, you can work the organ as you wish. Also 
you can by working upon the abdomen aid to lift the parts. T have already 
shown you how that is done. That is, you raise it with the patient upon the 
back as I have shown you, or with the patient upon the side, or standing bent 
at a right angle, and you, pushing the fingers in deeply over the abdomen, 
raise bodily the contents. It is also a good idea to have the patient practice 
taking the knee and chest position and siini)ly dilating the passage, the at- 
mospheric pressure will sometimes be sulficient to cause the uterus to take its 
place; also the motion I showed you at the last meeting, having tlie patient 
lie upon the back and fiex the thighs, thus stretcliing tlie psoas muscles, and 
push the legs apart while holding them together, and draw the legs together 
while they are held apart. 



189 

Treat especially the centers mentioned, that is, the second, which is the 
blood supply for the uterus, and the fifth, which is the center through which 
we reach the hypogastric plexus, and all along the lumbar and sacral region in 
general, but do not fall into the error of thinking the trouble is always there, 
because the lesion may be above or below the center at which you would natur- 
ally expect to find the trouble. 

I have already mentioned the point that you should stimulate the coccygeus 
muscle through the sacral plexus, and thus cause it to contract and aid in rais- 
ing the contents of pelvis. You can also stimulate the round ligaments which 
pass over the pubic arch just external to the symphysis ; you can find 
them both by the feeling and by the sensitiveness, because when you impinge 
upon them you will always have an expression of pain. Stimulation there will 
help to draw up the uterus ; all these things help a good deal. Stimulation at 
the second lumbar is used to cause contraction of the longitudinal fibers of the 
uterus, while stimulation of the clitoris and round ligaments is used to cause 
contraction of the circular fibres of the uterus. Consequently, we inhibit over the 
clitoris and round ligaments to cause them to relax and thus relax the circalar 
muscular fibres of the uterus. That is one of the most important points in 
Osteopathic obsteterics. 

In young females and in pregnant women it is advised never to give an 
internal treatment. Mrs. Patterson says that remarkably young children are 
sometimes suffering from prolapsus, and mentions a case in which the patient 
was not over two years old, but the case was entirely cured by external treat- 
ment. Should you be treating a case for other troubles in which the patient is 
pregnant, carefully avoid the ninth and eleventh dorsal and the second and 
fifth lumbar, in fact, the whole lumbar region. 

Dr. BoUes has mentioned a point to me which is extremely interesting and 
I think extremely important also. In a case in which there had been abortion 
and the mother had kept wasting from the uterus, a discharge of matter and 
flow of blood, he directed her to rub the nipples each morning with vaseline, 
and thus to stimulate as far as possible the normal irritation made by the suck 
ling child. He was thus acting in accordance with nature, and the discharge 
ceased. In another case he followed the same rule, where the woman was in 
difiiculty, the pregnancy was about three months along, and the indications 
were that the foetus had been dead for some days. The nipples were stimu- 
lated, which caused contraction of the uterus, and the woman was delivered of 
a still-born child. There is a very close connection between the nerves of the 
breast and of the uterus. It is a very good point in flooding — profuse menstu- 
ration or in flooding after child-birth, or in pos-partum hemorrhage, which is 
a very serious thing, to give a quick jerk at the mons veneris, thus causing 
pain and causing a contraction ; that will usually stop the flooding. I knew 
of a case not many months ago in which the flooding was persistent, and lasted 



190 

for some time. I sent word to the patient to try that treatment that I have 
described, and the flooding ceased immediately. Also in case of post-partum 
hemorrhage the '^Old Doctor" says you should simply insert the fingers and 
press upward against the os. He presses up and inward to smooth out any 
obstruction which may cause the trouble ; of course there is some obstruction 
there which is hindering the proper flow of the blood and so causing the hem- 
orrhage, and simply that pressing up allows the blood vessels to resume their 
normal relations and the hemorrhage to be stopped. Of course you under- 
stand when 3^ou come to treat uterine troubles, it is a subject for the specialist, 
and you will get this subject fully treated in gynecology and obsteterics. I 
caunot do more than simply mention to you the usual treeatment ; this will 
also be the case later in this lecture when I will take up the subject of disloca- 
tions, you will get them more fully in surgery, but I will give you the usual 
Osteopathic tratment for them. 

In examination per rectum, which is frequently resorted to by the Osteo- 
path in the female, if you will at the same time insert a catheter into the urethra 
you can feel the urethra along the anterior wall of the vagina. Here is an 
important point which I have never heard mentioned except in connection 
with Osteopathic practice. If your vaginal w^alls are relaxed and have fallen 
in response to a prolapsed uterus, you may very likely get a twist or an ob- 
struction of the urethra through the prolapsus of the vaginal walls. There 
have been some cases of that here, and it has been readily cured by smoothing 
out the vaginal walls in the manner I have described and by passing a catheter 
up the urethra, simply straightening out the urethal passage. Besides that 
you will find in digital exploration of the rectum the grip of the external 
sphincter, and you will be able to judge, by practice whether or not it is nor- 
mal. The normal grasp of the external sphincter is extremely powerful, and of 
course in all these internal treatments you should insert the finger only after it 
has been well oiled with vaseline, soapsuds or something of that kind. You 
will have no difficulty in inserting the finger into the rectum ; the palm should 
be turned toward the coccyx, and the finger inserted with its palm toward the 
coccyx, and may then be turned; the patient may be on the left side, or may 
be stooping bent over the table. You will also in j^our practice, no doubt, 
come across cases of prolapsed rectum, the gut may be prolapsed and be folded 
upon itself in just the way the vagma prolapses. In Chicago I had a case in 
which the patient came in in great pain, there nad been rectal prolapsus, and 
there was a great tenesnuis — a feeling of wanting to go to stool continually. 
It was extremely painful and the patient was able to walk only with great difli- 
cuity. I surmised at once that there was prolai)sus, and T inserted the finger 
and crowded the walls of the rectum upward all the way around. 1 w:is able 
to relieve the case and he had no trouble for some time afterward. In such a 
case you must adopt the method of treating over the spine to stimulate the 
nerve force and blood supply to that part, and thus iiivo [lernianont relief. 



191 

In the male, you will find, after inserting the finger for about two inches 
and turning it forward, the prostate gland. It is said by some authorities that 
the prostate gland is almost universally enlarged in men over forty years of 
age. The enlargement of the prostate is frequently the cause of stricture of the 
urethra. You will find the lateral lobes of the gland enlarged or the cen- 
tral lobe may be enlarged. Should the lateral lobes be enlarged there may 
not be mutjh difficulty, but if the central lobe is enlarged you are yery apt to 
have stricture of the urethra. All of these internal treatments should be re- 
sorted to only in case of necessity; you should not treat internally very fre- 
quently, not more than once a week, and sometimes not more than once in two 
weeks or a month. Be very careful in treating internally, as you may irritate 
the internal parts. When the prostate is enlarged it may set up considerable 
irritation, and curing that may be the only way of curing certain genital 
troubles in the male The prostate is very easily reduced, you can reduce it 
in half a dozen treatments, treating once a week or once in two weeks. 

Q. Is it reduced by local treatment? 

A. By local treatments. Of course you must couple with that treatment 
over the internal iliacs to tone up the blood supply. 

II. Osteopathic Treatment of the Limbs : In consideration of the arm, 
the ball and socket joirt is the one most hkely to be dislocated. First I will 
describe the ways in which this dislocation may o^cur : The dislocation of the 
humerus may be downward in the axilla, it may be backward upon the back of 
the scapula, or in front under the clavicle, or it may be slightly upward, called 
a partial dislocation, against the coracoid process. Now, the treatment for 
any of these is practically the same. One good way adopted by the practice is 
to put the knee under the axilla firmly, of course you would have an assistant 
holding against the patient to exert counter pressure. We would then pres- 
the arm down strongly in this way, and out, and thus spread the joint, brings 
ing pressure upon the contracted muscles and upon the ligaments, and they 
will diaw the bone down into place. Another way is when the patient is lying 
upon the table, simply to place the foot in the axilla in this way, and you can 
get a powerful leverage, as you see, and you can force the arm out into its 
socket. I do not know just how frequent the dislocation of the shoulder is in 
practice, but I do know that in gymnasium practice the shoulder is very fre. 
quently dislocated and set by a move on the rings, without harm. This joint is 
usually set without difficulty; of course it must be set very soon after dislo- 
cation. 

In dislocation of the elbow, there are five different displacements. Both 
bones may be dislocated backward, both bones may be dislocated internally or 
externally, the ulna may be dislocated backward, or the radius may be dislo- 
cated forward into the hollow on the front of the humerus, or it may rarely be 
dislocated backward. One method described is to place the knee in the bend 



192 

of the arm, and then by having your assistant exert counter traction above the 
elbow, you can spring the arm down strongly in this way. That will do for the 
first three. When you have thus exerted considerable tension, enough to over- 
come the contraction of the muscles, the bones will slip into their places. When 
the radius is dislocated forward, of course that would draw the hand back, and 
by turning the hand toward the supine or half supine and exerting traction 
downward and outward in such a way as to pull the head of the radius down 
into position, you will be able to work it into place. 

In dislocations of the wrist both bones may be out of place, the radius may 
be forward or the ulna backward, and in all those cases simple extension is re- 
quired ; you have your assistant fix the elbow and then you exert powerful 
traction upon the parts until they have been drawn into place. 

In dislocation of the fingers it is said dislocation is usually between the 
first and second phalanges, and there, also, simple extension is required, draw- 
ing straight upon the finger until the bone is slipped back int > place. Dr. Har- 
ry Still says, in his own peculiar way, that if a bone is out all you have to do is 
to move it around enough and it will want to slip back into place. As to the 
usual way of treating the arm, you have seen that we frequently use it as a 
lever. In some cases, as for instance in articular rheumatism, we work with 
the idea of spreading the joint and allowing the blood and nerve force to be 
freed about the joint and especially allowing the inflow of the blood, the stimu- 
lation of the blood flow thus removing the deposit in the joint. You can read- 
ily stretch the joint ^j doubling the hand and putting it under the axilla and 
then pressing the arm in against the side. That, of course, will draw the shoul 
der down, and I have had some very good success in relieving cases of articular 
rheumatism in that way. In spreading the joint you can also stimulate. Place 
your hand upon ihe front of the elbow and then bend the arm strongly over 
the hand ; that will spring the joint ; and also by turning it out at a right angle, 
you know how the olecranon process catches at the back of the humerus, by 
bending the arm at a right angle so that they will catch you can exert pressiwe 
in that way to spread the joint. Also you can stimulate the flow of blood 
down the arm by getting a certain twisting motion in this way. That is one of 
Dr. Hildreth's movements. I have hold of the arm here and I am moving the 
head of the humerus in the socket. I twist it in that way without exerting 
much force. I might speak here of the fact that you can impinge upon the 
nerves of the inner side of the arm, the branches of the brachial plexus running 
down there, and the axillary artery. In general if you impinge upon an artery, 
press it toward the bone; do not press it toward the muscle. You will find in 
your practice that these nerves become paralyzed by the use of a crutch, sotting 
up crutch paralysis; and that is a point which it is well to take into considera- 
tion. Also we have found in our practice that something will catch here at tlie 
anterior part of the shoulder; whether it is deltoid fibers under the t'orai'oid 



193 

process or whether it is a simple binding of the ligaments drawing the head of 
the humerus out against the acromian or coracoid, it is hard to say, but we 
frequently find a catch there which we can reduce by drawing the arm upward 
and backward, and then, when horizontal, draw it outward, and having the 
fingers in front over the process there you can free any obstruction in that way. 
I do not know just what catches there, but I have seen cases of extremely lame 
arms which could not be raised higher than the head and could not be put be- 
hind the back, relieved by that treatment. Sometimes you will have such an 
injury as will cause a contraction of one of the heads of the biceps muscle 5 you 
know its attachments ; by straightening the arm and drawing it backward, thns 
lengthening the distance between the attachments of that muscle, you bring 
tention upon it. Frequently you will find that muscle contracted, and all you 
will need to do is to stretch it, thus inhibiting its nerve force and thus relaxing 
its spasm, ana you get rid of the trouble. 

In the treatment of the legs you have all seen the various motions we all 
go through withj perhaps you have not all appreciated what the purpose of each 
movement was. When I flex the thigh above the thorax and the leg upon the 
thigh I am stretching the quadriceps extensor muscles. You see you simply 
stretch it and with it you free the blood supply, the femoral artery and the an- 
terior veins and the anterior crural nerve. That is the purpose of this motion 
which you see so frequently employed. Sometimes, of course, we simply use 
this motion as leverage, having our hands in the sacro-iliac joints ; you know 
its purpose already. You have thus stretched the anterior muscles of the thigh 5 
you can stretch the muscles of the anterior part of the leg simply by pushing 
the toe straight down. That is a most frequent motion that the Osteopath uses. 
You can stretch the calf muscles in just the opposite way, by pushing the toe in 
the direction of the knee; and yon will have no difficulty in pushing it strongly 
enough. We can stretch the adductor muscles by holding the leg straight, 
standing between the legs and separating them. You can stretch the external 
rotators by an internal movement in this way : it is very well to regulate the 
force in this way : In making this movement turn just enough so that the patient 
turns on the side it is not necessary to use a great deal of force ; then turn 
the other way until you have turned him about the same distance. We may 
also stretch the muscles on the back of the thigh, you know that in raising the 
knee, for instance against the chest, you can only do it by bending the leg ; if 
you straighten the leg you can get it to a certain height, and then you teel ten- 
sion upon the hamstring muscles, consequently we frequently use that in our 
practice. Putting the heel over the shoulder of the operator and raising the 
limb higher than it can naturally go, you see it cannot naturally go quite to a 
right angle, you thus lengthen the distance between the points of attachments 
of the muscles on the back of the thigh and you stretch their tendons. Fre- 
quently you will find it important to stretch those muscle«. I had a case just 



194 

the other day of this kind, where the legs were drawn with rheumatism, the pa- 
tient had no use of the limbs, they were considerable drawn, the toes were turned 
in, the muscles set and it was with difficulty that I could handle them. I simply 
brought deep pressure in Scarpa's triangle on the anterior crural nerves, 
and that relaxed the anterior muscles. I had another case in which was paralysis 
of the lower limb, and frequently the limb would jerk when I would treat it, so 
I inhibited the anterior crural nerve and the limb would relax directly. So we 
pay particular attention to Scarpa's triangle since we can impinge upon the 
femoral artery and upon the anterior crural nerve. Also we treat in the popliteal 
space ; we very frequently knead it or work its contents, simply bending the 
knee, putting the foot of the patient between your thighs and working^ the fiat 
of your hand in the popliteal space ; you can thus free any contraction there 
and can stimulate both the popliteal nerves and the blood vessels. 

Frequently in cases of rheumatism you will have trouble with the feet. 
You can straighten them down forward as I have shown, or backward. In treat- 
ing the feet you will see that there are two natural arches, one lengthwise of 
the foot and one crosswise of the foot ; consequently in your treatment of the 
feet you can break it in two ways — you can spring it down toward the toes and 
can work with both hands beneath the instep and spring it toward the sides. 
In doing that the principle is that you stretch the ligaments about the joints. 
You can stretch the ligaments at the articulation of the ankle by this forward 
and backward movement and by working it from side to side. By bi caking 
the two arches of the foot as I have shown, you can relax all of the ligaments 
across the arch of the instep. Of course the toes can also be treated in the 
same way. We frequently are called to treat for corns along with the rest of 
our treatment, not that any one pays us $25 for treating their corns, but if 
they have something of that kind the matter with them they always want you 
to put that in. When you are treatins^ a toe, you know the vessels run dowu 
the outside ] simply spring it from one side to the other ; that will stretch the 
ligaments and the blood vessels and stimulate the nerves. 

Q. Would that treatment cure a cramp in the foot? • 

A. It would depend upon the cause, if the cause were in the foot it 
would. You could very well cure some cases. 

Q. Would it cure cramps on the bottom of the foot? 

A. It would depend upon' where your obstruction was: it might be 
higher in the path very likely. You would have no trouble in curing it in 
the foot; I have found that in my own case, by simply stretching it. Kvory 
one naturally does that; some people are much troubled by cramping in the 
feet. 

It frequently becomes the duty of the Osteopath to stretch the sciatic 
nerve thoroughly by stretching in this way, the heel of the [)aticnt over oper 
ator's shoulder, and lengthening the distance along the back of the log. and 



195 

then since the branches of the nerve run on down over the planter surface of 
the foot simply pull down on the toe and you can stretch the sciatic nerve 
considerably. Also, in treatment of sciatica it is one of the treatments to 
work the limb outward in this manner, thus to relax the muscles throughout 
the whole course of the sciatic nerve, or, by an inward turn, the pyriformis 
and those short muscles, the external rotators which may impinge upon the 
nerve. 

As to dislocations. — Frequently you get a dislocation of the ankle, the 
foot may be thrown outward, in which case you have an inward dislocation; 
or it may be the reverse, or these bones may be thrown forward upon the 
ankle, in which case you have a forward dislocation. In a few cases you have 
a backward dislocation. The movement is to have your patient lying down, 
flex the knee at a right angle, have your assistant fix the knee so that he can 
exert counter-extension, then you simply stretch and bend the foot in the di- 
rection in which it would go. If it was thrown outward stretch it and bend 
it inward, and vice versa. We do this in the case of the toes, simple exten- 
sion is the method employed. In the case of the knee the dislocations also 
are four: inward or outward, forward or backward. It is said simple exten- 
sion is enough. However, the Osteopath uses this movement: he flexes the 
knee at a right angle, and then reaching in at the popliteal space he grasps 
both the internal and external hamstring tendons and pulls outward with the 
idea of spreading them, drawing them away from the prominences at the end 
of the femur; and then he pulls with considerable tension and attempts to 
spring the joint back into place. 

Dislocation of the knee is rather serious as it is especially apt to be fol- 
lowed by inflammation. 

As to the hip. There are four dislocations described for the hip. One 
is upward and backward upon the dorsum of the ilium, in which case the leg 
is shortened and the toes are turned inward. Another is backward into the 
sciatic notch, in which case also the limb is shortened, though not so much, 
and the toes are turned inward. The third is forward into the obturator for- 
amen and is called the thyroid dislocation. It is the most difficult with which 
we have to deal, and when such is the case the knee is bent, the toes point to 
the ground and may rotate inward or outward; and in the other case the head 
of the femur if forward upon the pubic arch and the turn of the toes is in- 
variably outward. So you have two in which it is always inward, one in 
which it may be inward or outward, and one in which it is invariably out- 
ward. Of course dislocations when thej^ are new are fairly easy to reduce, 
but the Osteopath gets them almost always when they are old. Your treat- 
ment must first be directed to softening all the ligaments and the muscles, re- 
moving the unnatural tension, and thus get the hip ready to set. These old 
cases are almost always slow to set, though I have seen some long standing 



196 

cases set in a few treatments. You always have two factors of great aid to 
YOU, one is the anterior ^^Y" ligament of the hip joint and the Dther is the 
action of the small muscles, the pyriformis, obturator internus and externus, 
the two gemelli, and the quadratus femoris. They are attached in such a way 
as to draw on the great trochanter. When it is up, they are below, conse- 
quently they are of great importance to us in setting a hip. If the hip is up 
and back, you simply flex the thigh still more, turn it inward strongly until 
you get the tension of those muscles, and then throw it outward, and get the 
head of the femur to travel just over the edge of the ascetabulum. That looks 
very easy, but I will assure you it is not. When it is dislocated backward 
into the sciatic notch, the idea is to flex the thigh, work the knee inward to 
disengage the head of the femur from the notch, and then work it upward and 
forward in this way, and you get the head of the femur drawn toward the as- 
cetabulum. When the dislocation is forward into the obturator foramen you 
are usually in difficulty. The motion described for that is to flex the knee 
and to rotate it inward, using the attachment of the ^^Y" ligament as a fulcrum 
against which the limb works. Flex the thigh and work the head of the fe- 
mur inward or toward the cotyloid notch. In the fourth dislocation, where 
the head of the femur is over the brim of the pelvs, considerable tension is 
exerted backward, long enough to stretch these ligaments, and then try to 
lift the head of the femur over and across. 

In diagnosing the hip dislocations you frequently find it very difficult. 
If your dislocation is backward into the sciatic notch, you limb will be a lit- 
tle shorter, the toes will be turned in, and when the patient sits up you have 
a shorter limb. While if it is forward it always lengthens the limb for the 
patient to sit up. Of course, as I have said, these things get out and stay 
out for a great length of time, and we have a great deal of trouble in getting 
them back, and I believe of all the hard dislocations, the most difficult to 
treat is the one into the obturator. 



LECTURE XXVIII. 

There are two or three points to which I neglected to call your attention 
at the last time. I mentioned treating the prostate gland, but did not show 
you how to treat it. You know how to find the gland, and working down 
across it on each side with a fairly firm pressure, just to stimulate the tlow of 
blood throuojh it, is the motion employed. 

Also as to the saphenous opening, we treat that by stretehino- the thigh 
which has been flexed outwards; that will enable you to stretch the nuiseh^s 
about that oj^ening, then by rotating the limb inward and relaxing the mus- 
cles, you can work yonr fingers in at the opening, you stretch the nuisoles about 
it and free the opening. 



197 

Tenesmus in the lower bowel occurs frequently in diarrhea and in other 
troubles. This can be relieved by working over the sacrum, especially over 
the muscles to stimulate and thus cause a contraction of the sphincter and a re- 
lief of the feeling of tenesmus. 

Frequently after parturition the disease known as milk leg, or phlegmasia 
dolens, occurs, and is probably due to a contraction of some of the short mus- 
cles, probably the pyriformis ; it sometimes happens tha;t the hip has been 
thrown out in the efforts of parturition. Always after attending such a case 
the hip should be turned to see that it is properly in place, and see that the 
muscles are properly stretched. The saphenous veins should be treated also. 

Q. How would you treat for fainting! 

A. By the common methods employed — anything to lower the head ; some 
people, for instance, when they know they are going to faint, as some do, will 
drop over the back of a chair, with the head down, and that will stop it. When 
such has occurred, get the head of the patient lower than the feet, you can then 
have him hang his head over the end of the table at the foot ; or you may shock 
him, pull the hair, or a simple slap will draw the blood to the head when it is 
exhausted. 

Q. I have a case in mind in which bleeding of the nose occurred and last- 
ed four or five hours before it was stopped, and the patient finally died. What 
would be the treatment? 

A. To check epistaxis or bleeding from the nose we work in the superior 
cervical region, stimulating j that is frequently of use. Or you may hold the 
facial artery where it crosses the angle of the jaw, or hold the nasal branches 
just here at the inner canthus of the eye. Hold them strongly. That is the 
usual treatment, particularly the stimulation in the cervical region. 

Q. In case of a lady whose babe is about fifteen months old ; since the 
birth of her child she has had an extremely sore mouth ; the condition of the 
alimentary canal has been such that she could not eat but a very light diet j 
diarrhea all the time, and a gradual wasting away of her strength and muscular 
system until she is almost a skeleton. What could be done Osteopathically? 

A. What we would describe as a general treatment should be given ; a 
general spinal treatment to tone up the nervous system particularly, reaching 
especially the centers for the bowels, the splanchnics, and reaching also the 
kidneys and the liver, toning up the secretory and excretory organs, and keep- 
ing the system in as good a condition as possible. 

Q. It IS the disease known among the medical profession as nurse's sore 
mouth : there is also uterine trouble. 

A. You wruld have to look after that also. The trouble is probably of 
nervous origin. 

Q. In the case of a person taking a hard cold, or the disease known as la 
grippe, how would vou treat? 



198 

A. I would give a strong stimulating treatment. That is a thing that is 
very important. I have already spoken of the effects of lagrippe several times, 
and I have found the most serious results following it after a long period of 
time. Have the patient on the face for the first. This treatment will also 
apply to what is called a bad cold, and I have had some excellent results in 
treating bad colds, and you can usually cure them. Use this general treatment. 
You know the purpose of the treatment — to relax first all the muscles. With 
the condition brought about by la grippe there is usually a painful aching of 
the back, especially along the lumbar region. I then have the patient on the 
side, and having loosened the muscles as shown, I would spring the spine all 
along by working underneath ; you know the various motions. You can separ- 
ate the pelvis and the shoulder by putting your two arms between them and 
springing the spine. Then for this backache in the lumbar region, I would go 
particularly to the fifth lumbar, having first loosened all along the lumbar 
region and springing the spine in the good old Osteopathic way. The ache 
there is probably caused by the tension of the ligaments, and while we usually 
use an inhibiting motion to free one from an ache or pain, it depends upon what 
it is caused by. If it is caused by the contraction, as it probably is in such a 
case, the relaxation of the ligaments should do the work. I would then treat 
for the kidneys with the patient on the back ; reach underneath and stimulate 
along the region of the lower splanchnics and upper lumbar. I would also in 
that case treat the liver and the bowels. Give the neck a thorough treatment ; 
I have already explained all these things in detail in going over the parts of the 
body. Of course the neck is a part of the spine and you must be particular in 
watching there to see that this contracture of the deep muscles does not affect 
important nerves, as it may very readily do. Use the motions given ; first relax 
all the muscles, then work deeper and spring the neck to relax the hgaments. 
Of course you can work from side to side in this way, and before completing 
the operation I would give the straight pull as you see here, and the bend of 
the neck, enough to raise the patient's head and shoulders from the table. 
That motion, of course, will give a stretching motion all along the spine. Then 
I would free all about the head and face, the points of the fifth nerve, those 
places at which you know how to reach it. I would free all of the parts about 
the face. To free the nose, press firmly upon the forehead, spring the jaw 
down, and work thoroughly at the styloid processes. It would not hurt to 
work the arras and lower limbs, in fact, go all over the system to loosen any 
structure, either muscle or ligament, which may be contracted by the effects of 
la grippe. 

Q. What would you consider a few of the most essential points in con- 
sideration when a patient first comes to see youf 

A. That is a very good (piestion, \ think, becaus*^ it involves the (piestion 
of how to start about an examination. 1 would first take the pulse; it is my 



199 

habit to do so, I do not know that it is necessary always ; others, I beheve, do 
not do it, but the pulse is always considered an indication in diseases. I would 
then ^o to the spine and examine it thoroughly, but of course I would be ques- 
tioning them as I went concerning all the symptoms. In fact, before taking 
the pulse I would ask them all about the trouble ; I would get the subjective 
symptoms. 

Q. Do you think the history of the case is essential, then? 

A. Yes, sir, it is. 

Q. Please give the treatment for goitre. 

A. For goitre we would give essentially neck treatment : I will not need 
to show it to you. Frequently goitre is caused by an obstruction of veins- 
However, I think it is often caused by some impingement upon the nerves sup- 
plying the arteries and veins, consequently you have an obstruction there. The 
idea would be to thoroughly relax all the muscles and ligaments about the 
neck, give the neck the straight pull and the turn from side to side, and bend 
it backwards, since there are anterior muscles in the neck which you must take 
into consideration. Sometimes it is those muscles which are contracted and are 
pressing down upon the nerves and vessels. If it is a hard, encased goitre 
with a fibrous capsule, it is very difficult to cure. If it is an ex-ophthalmic 
goitre you will have difficulty in curing it but the ordinary goitre is dealt with 
with considerable success, although it frequently takes considerable time. In 
treating for goitre I would also, besides the general treatment, work locally 
over the thyroid gland, which you know is the gland enlarged in goitre, work 
across it from side to side, to free the veins there. 

Q. How would you treat enlarged parotid, submaxillary or subhngual 
glands, exceedingly large ones? 

A. Do you know what caused it? 

Q. Not unless it was scrofula. 

A. That was probably the cause. 

Q. Can you cure that? What would you do for it? 

A. I should give the treatment for the general system first ; we must get 
rid of what is causing it, whether it be impurities in the blood or a scrofulous 
condition, or anything of that kind. Any case would depend upon general 
causes to some extent, and you would have to give a general treatment to 
purify the blood. That is, attend to all the avenues of secretion and excretion 
and of assimilation and nutrition in general. The local treatment would then 
be confined to loosening all the parts and freeing the blood and nerve supply to 
the organs affected. 

Q. Please give the treatment for reduction of fevers. 

A. In the first place it is said that when there is fever in the body that it 
is made by the refuse not being cast off, and hence being burned. Nature is 
making an extra effort to burn the refuse, and hence is causing a fever. Wheth- 



200 

er that be true or not, 3^011 know that there is in many cases almost a complete 
suppression of \irine in fever, or if not so much as that, that the urine is 
scanty and hi^h colored. You must go to the kidneys and free their action. 
Go also to the bowels and free their action; combine the general treatment. 
Look for the cause ; of courss it would depend upon what kind of fever it was ; 
and then having treated the particular cause, the Osteopath also goes to the 
superior cervical ganglion and inhibits the action of the heart. You can in- 
hibit the superior cervical ganglion either opposite the transverse processes or 
in the sub-occipital fossae. Then give the treatment in the upper dorsal region, 
stimulating the action of the lungs to help them to carry off the poisonous mat- 
ter in the body. Also treat the splanchnics. In general, go to the cause. I 
suppose you have heard Dr. Still's theory of fever — he says that the lung is 
not acting properly, that the gases are not properly condensed, and he treats 
fevers through the lung a good deal, to get it to act properly that the poisons 
of the body may be excreted properly. 

Q. Would you treat the vagi in fever? 

A. Yes, sir, we would treat them for the general effect on the liver and 
intestines, and you could stimulate them to inhibit the pulse. Of course you 
have not cured the fever simply by slowing the heart, that is an adjuvant. You 
must go to the first cause ; having done that work I should also go to the 
splanchnics, as I have said, and should inhibit there ; having inhibited the cer- 
vical, I would inhibit in the middle dorsal region or along the splanchnics and 
then I would go to the fifth lumbar, where you get the center for the hypogas- 
tric plexus and through it the pelvic plexuses. Your object in doing that is to 
dilate the vessels, and thus inhibit the vaso-constrictors and stimulate the vaso- 
dilators, or you tend to restore things to the normal. In other words, you 
free the body, free the parts affected, and dilate the abdominal veins. In that 
way you equalize the circulation. That is just part of your general work, and 
it depends on the kind of fever ; in typhoid fever you have to go to the intes- 
tines and treat them. 

Q. How do you treat chills? 

A. Stimulate the heart to propel the blood faster; stimulate the lungs so 
that the blood will be better purified. 

Q. Where the fever follows the chill as soon as it is over, would you be- 
gin treatment for the fever at once? 

A. If I supposed it would come on right away; I would be on the watch 
for it; I do not know that I would begiu to treat immediately. But having 
taken those general points together, I would also combine with that general 
spinal treatment and treatment for the heart, a general .stimulating treatment, 
and in some cases it might not hurt to stretch the limbs, and do all you can to 
stimulate the flow of blood through the body. In chills and fever treat espec- 
ially the liver and spleen. 



201 

Q. Just about what you would do for a cold or la grippe? 

A. Largely so in that general treatment. Then they say that rapid rub- 
bing upward along the spine, hard and quickly, will CLuse a chill to cease. On 
one of the hot days last summer I was called to a case ; it was not a regular 
chill, but the person had become over-heated, and the blood had left the sur- 
face of the body. He felt extremely faint, had difficulty in standing up, and 
was covered with a cold, clammy perspiration ; the surface of the body was 
chilly. I immediately stimulated the heart and lungs, inhibited at the superior 
cervical, and gave a general treatment to equalize the blood and keep it circu- 
lating. 1 had the patient keep quiet and he soon felt all right. 

Q. I would like to know what treatment you would give for vaso -dilator 
effect and for vaso-constrictor effect, to inhibit the flow of blood or increase it. 

A. I do not know that I would give any in that way. For instance, go 
to the splanchnic s, they contain both vaso -dilators and vaso -constrictors, go 
to the sciaticSj they also contain both. Is'ow, I cannot treat the sciatic or the 
splanchnics and cause that particular set of fibers to act alone, that is, I do 
not know that I can, and frequently I employ a method which I say will in- 
hibit and frequently do that w^hich we say will stimulate, and no doubt we 
do so. As near as I can describe it to you, a treatment to stimulate, and a 
holding pressure over the root of the nerve will inhibit. It is very hard to 
say just what we do there, I tend more and more to the belief that we simply 
restore something that is abnormal to the normal conditions, and allow nature 
to do the rest. I think that is the best theory by which we can explain so 
many things, and there are many things we cannot explain by the theory of 
stimulation and inhibition. 

Q. If a person faints from overheating, is not there any special treat- 
ment besides holding the head down. Dr. Charleys Still seems to have had 
good results in that trouble"? 

A. In such a case you would also have to direct your attention to the gen- 
eral condition. In case of overheating, where there is an inward congestion, 
very likely the blood is prevented from flowing to the head and is congested 
about the lungs particularly, and about the intestines, since there the veins di- 
late the most readily and hold the most blood. You would have to apply jour 
stimulating treatment, and cause the blood to circulate freely. 

Q. I would like to know why it is that nervous prostrations is so much 
more a general complaint of ladies than gentlemen, and what treatment you 
would advise. 

A. Nervous prostration is a very serious thing. Whenever I can. I ad- 
vise against studying too hard and too long at a time, according to the patient's 
constitution, of course. A person can stand only a certain amount of work at 
a time. For myself I make it a rule not to work extremely hard longer than 
two or three hours at a time. I can work four hours or more at a time, but I 



202 

do not do it often, I do it when it is necessary. In ray regular work where I 
can regulate my hours, I will have something to break in at the end of about 
two hours. It is a question of personal experence and personal taste, although 
one may work too long and too hard. I have seen a number of cases of ner- 
vous break down from over study, I have seen them in college, and I do not want 
any in mine. It is caused by lack of exercise, lack of fresh air, sedentary hab- 
its, too much stimulants, as tea or coftee, and two much of a strain on the men- 
tal faculties. To prevent that, the prophylactic treatment would be to regulate 
the habits of the patient as far as possible, get them to take plenty of exercise, 
etc., because when the trouble has once come on, it is in the majority of cases 
hard to get over, and almost always leaves its effects. And then as to our 
Osteopathic treatment, the treatment will have to be general, since the nervous 
organism is exhausted, you will have to generally tone it up, and it will take 
considerable time and general treatment. 

Q. Give us the treatment for diphtheria. 

A. Diphtheria of course is a constitutional trouble, and when a patient is 
sick with it, he is sick all over. You will have to prevent the membrane form- 
ing if possible, and that can be done very nicely. Dr. Charley Still has had the 
very best experience, more than any other Osteopath, he had a remarkable run 
of cases in Red Wing, Minnesota, and had remarkable success. His treatment 
was very largely about the neck and throat, he would treat there to keep the 
blood supply open, you know how to do it, free all the muscles and ligaments, 
and especially keep the anterior muscles softened and luose so that there can be 
no tension there and any stoppage of the blood so that an excretion can grow in 
the throat and form a membrane. You must attend to the bowels and the kid- 
neys and the general health. 

Q. When the membrane does form what do you do? 

A. To cause the patient to yomit is one way, in order to throw it out, and 
there are certain drinks that they use to loosen the membrane. 

Q. How often should you treat in diphtheria? 

A. Dr. Charley Still said that he frequently would come back to a case 
jnside of fifteen or twenty minutes. He was unprotected by the law and he had 
to go very carefully or he would have had trouble. 

Q. Did he treat for the fever? 

A. Yes, you would have to treat for that according to the treatment out- 
lined. 

Q. In any acute trouble of that kind would you just treat for the symp- 
toms you see, unless you find some lesion? 

A. No, sir, that is hardly our method, we should try to find a lesion, in 
the spine particularly, and you would probably be successful. 

Q. Suppose you did not find a lesion? 

A. If you didn't find a lesion you could only go acA'ording to principles and 



203 

work on the centers indicated, but you will find lesions or contracted muscles, 
or something of that kind. 

Q. Give the treatment for granulated eyelids. 

A. In granulated eyelids, first, of course, you must turn back the lids 
and examine whether or not the granulations be there. Usually there is con- 
siderable stretching and irritation and the eyeball is inflamed, then you will see 
the granulations existing as little white points all along on the inside of the lid, 
3^ou may find them on both lids. Our treatment tfiere locally is. after having 
wet the finger with a little soap suds, or having vaseline on it, to gently work 
all along under the edge of both lids and to rub on the outside of the lids as you 
fi^o along ; that will crush the gradulations. Some say that the granulations 
are caused by the stoppage of the ducts of the Meibomian glands. '^Old Doc- 
tor," however, says that there is some obstruction to the veins, that the blood 
is brought to the eye and cannot get away, consequently it must do something, 
and it goes to work then to build up some foreign growth. That seems to be 
the most reasonable theory. If you want to know particularly about granulated 
eyelids, ask Dr. Hildreth ; he had quite a remarkable case, which the ''Old Doc- 
tor" cured. Having treated the granulations, treat the points of the fifth nerve 
over the eye here, on the forehead, at the inner and outer canthus of the eye, 
and at the supra and infraorbital foramina, to free the blood flow. Treat par- 
ticularly through the upper cervical region, and look for any lesion in the cervi- 
cal legion ; give the general treatment for the neck in order to keep the blood 
supply freely open to the eye. 

Q. Where the upper lid is drooping, would you give the same treatment? 

A. I would there stimulate the flow of blood and would stimulate the fifth 
nerve, since it is the muscular trouble, and you must tone up the muscles and 
and strive to get them built up through the blood flow. 

Q. Do you give the same treatment for cataract? 

A. You would treat particular through the fifth nerve for cataract, as 
the fifth nerve has to do with nutrition of the eye, particularly its anterior 
part. You reach it through the superior cervical, at the inferior maxillary 
articulation, and through these points that I have mentioned over the face. 
Also look for any lesion in the cervical region or in the upper dorsal. Give the 
general treatment of the neck. 

Q. In case of the eyeball turning inward, for instance the right one, 
through weakness of either the external muscles or increased strength of the 
other muscles, what do you do? 

A. I do not know just what the experience has been in regard to crossed 
eyes. However, I have known of cases being treated surgically, which is always 
to cut a few fibers of the muscle which is opposite to the one affecting the eye 
most — on the side pulling the most strongly ; that weakens that muscle and al- 
lows its antagonist to be more evenly balanced in its action. That will allow 



204 

the eye to become straight. But the trouble with that operation is that after 
the person has gotten well and the general health has increased, this weak mus. 
cle, if the trouble was of this muscle, will strengthen and pull too hard against 
the one which has been weakened by tbe operation. I have heard of such cases. 
In speaking of such troubles once before I asked Dr. Sheehan if he had met 
such cases and he said he had, where the cure was only temporary from that 
surgical operation, and the trouble returned. The treatment there Osteopathi- 
cally would be to strengthen the muscles. I have heard of a number of cases 
being treated. However, in cases of young children I think they are successful. 

Q. This is a case of a party about middle age and it came on suddenly. 

A. I would by all means try it in all such cases; where it comes on 
suddenly that way it may be a nervous trouble, it may be a slip in the neck 
somewhere. I would not send the patient away and say I could not cure 
him, not unless I was positive. It is pretty hard to be certain. In some 
cases the Osteopath can not tell until he has tried, and if he is conscientious 
he must treat his patients awhile before he is sure. 

Q. How would you treat for pneumonia? 

A. In pneumonia the trouble is in the lungs, and pneumonia is usually 
handled very nicely. The patient will usually have fever besides the trouble 
of the lungs. The simple osteopathic treatment is to stimulate the lungs, as 
I have shown, in the upper dorsal region all along on both sides. Find out 
particularly which one is affected by the methods which I have shown you. 
Treat for the fever- In children and old people it often follows measles or is 
a complication of them, and if you are called to a case of measles do not for- 
get that complication; in all cases look out for pneumonia. 

Q. Is there any way in which severe coughing can be stopped imme- 
diately? 

A. It will depend upon the cause of the trouble. If I were called to 
such a case about the first thing I would do would be to examine the pneu- 
mogastrics to see whether or not there was some irritation in the neck affect- 
ing them. Or if I could not find it I would inhibit the action of the pneumo- 
gastrics. There are laryngeal branches supplying the larynx w^hich may be 
irritated causing severe coughing. It may be some irritation of the pneumo- 
gastric in the stomach that is irritating the nerves and causing the coughing. 

Q. What would you do when it is caused from the lungs ' 

A. I would give a general treatment to the lungs. I would go to the 
lungs first and treat them. 

Q- In case the heart ceases to beat for a short time, say during sleep, 
and the person awakens and cannot breath until he has got on his feet 
or something of that kind, what would you do? 

A. I would raise the ribs on the left side. 1 would draw the arm back 
strongly while holding my other hand in a V shape under the angles of the 



205 

ribs. What you describe is probably some palpitation and may be nervous 
in cause. Perhaps the patient has lain upon the back for a certain length of 
time and has turned in his sleep and gotten two ribs compressed together. 
The idea there is that you give the heart more room mechanically, by raising 
the ribs, and that you stimulate the splanchnics along the spine which we 
reach along the upper dorsal. 

Q. Give the treatment for rheumatism. 

A. There are several kinds of rheumatism. In any case we go to the 
kidneys, we treat them always in the manner shown, to free the system of 
the acid which frequently is present in a case of rheumatism. Sometimes 
acute rheumatism comes on without any other previous form, that is, it be- 
gins as articular rheumatism, and will strike one Joint, say the shoulder, and 
next it will be in the knee of the opposite limb, the following day it will be in 
the forearm, then in the wrist, and it jumps about from place to place. In such 
a case we would stretch the joint, separate it. I would also for this shoulder 
work along the dorsal region, loosening the muscles there, any contraction; 
then I would stimulate at the origin of the brachial plexus, along the scaleni 
muscles, between which the branches of the plexus run out to the arm; 
raise the clavicle, stimulate the subclavian artery, and in general, thoroughly 
relax everything about that arm and free the forces of life to it. I would do 
that for any joint affected. In case of muscular rheumatism you must treat 
very gently, treat the blood and nerve supply to the part and work over the 
muscles affected very gently, that is, bring gentle pressure and stretch them 
very gently. I have known of a case of general muscular rheumatism where 
we simply went over the patient, gave him a gentle treatment, stretched the 
muscles and the ligaments and stimulated the kidneys and the liver and the 
general excretory organs. 

Q. What is the treatment for flux"? 

A. The same as for diarrhea, I believe I showed that at one time. The 
chief thing which we do is to work strongly along the lumbar region, spring 
the spine strongly, and hold against it. I have seen cases treated in that 
way, just as you see me doing here, the point of the knees against you here, 
and hold against the eleventh and twelfth ribs, inhibiting the action of the 
nerves there to stop the rapid peristalsis, that is the theory. You can do 
that by setting the patient upon a chair, get your knee against the heads of 
the eleventh and twelfth ribs, and pull the arms up and out, and you thus 
get a strong pressure against this point. I would also stimulate the flow of 
bile. I described to yon not long ago a case of flux of long standing; in that 
case I found that the two lower ribs were too close together on each side, and 
that there was a contraction anjd smoothness along the lower lumbar region. 
I relaxed that and straightened the ribs, and it took but two treatments to 
cure the case. 



206 

Q. Please give the treatment for catarrh. 

A. That is general treatment of the neck, and is what I have already 
given, but I might mention a few points. They say always that there is a 
tender place under the angle of the jaw. It will hardly be necessary for me 
to show you all these motions. The theory there is that some contraction, 
either recent or of long standing, is shutting off the blood supply to the 
membranes of the throat and nose. 

Q. Do you treat in the mouth? 

A. We sometimes treat through the mouth. You can put the finger 
back and work from the top of the palate down along the pillars of the fauces 
on each side; we sometimes do that. 

Q. How would you treat a sprained ankle or knee? 

A. Say it was the knee, you must be very careful, if it is a recent case 
and there is swelling about it you must take the swelling down. I would not 
move the member much at first, and the best way that I know to reduce a 
congested condition from infiammation after severe strain is the use of hot 
water, hot bandages or the hot water bottle, or something of that kind. After 
having reduced the swelling you can see if the parts are dislocated, examine 
to see if they are out of place or if there is any break. Of course if you are 
called at once to the case you can find that out at once. You should always 
do that as early as possible, find out if there are any dislocated parts, and if 
there are you must put them back as soon as possible. If there are no 
broken or dislocated parts, after having taken down the swelling principally 
by the use of hot applications, I would work gently at the popliteal space to 
relax the muscles and stimulate the popliteal vessels, then I would bend the 
thigh up and stretch the muscles about the saphenous opening to allow the 
blood flow above to be properly opened, and give the stretching motion to the 
leg to relax its muscles in general. I should then treat along the lower part 
of the spine, especially where we reach the sacral plexus, so as to stimulate 
the nerves to the leg. 

Q. Those movements would be rather painful, would they not? 

A. You will have to be very careful, perhaps you cannot do them at 
first. I have had cases of sprain where I would not manipulate at all for 
several days; I just used the hot applications about it, and watched to see 
that no trouble took place, but it was several days before I began to manipu- 
late. At first you can treat the lower part of the spine without moving the 
leg, and I would do that. In these cases I have had good success. Some- 
times your strain will not be painful, and you can manipulate the log from 
the start; it depends altogether on the conditions. 

Q. Has Osteopathy come in contact with yeUow fever or cholera, and if 
so, with what success? 

A. The ''Old Doctor'' savs he has treated cholera. 1 do not know that 



207 

we have ever had any cases of yellow fever. About all I know about the treat- 
ment for cholera is that Dr. Still says he treated the lungs, he was speaking 
on that the other day in relation to his theory of the formation of gases in the 
lungs, and also stimulated the excretions. 

Q. What is the treatment in Bright' s disease! 

A. In Bright' s disease treat for the kidney. Bright' s disease is a gen- 
eral name. However, it refers to a disease of the parenchyma of the kidney, 
and there are various forms. You would have to look for any lesion affect- 
ing the kidney along the lower dorsal region or at the second lumbar, and 
your idea there would be to work upon the nerve supply to the kidney by 
treating over the spine. Then you could work at the umbilicus, as I have 
shown you, to get these centers, or you can reach them by deep pressure over 
the renal ganglia, which lie on the renal arteries. 

Q. How do you regulate the action of the kidneys when they are acting 
too frequently? 

A. When the kidneys are acting excessively or too frequently, the idea 
is that you must find any lesion which may cause an irritation or inhibition 
of the nerve force. It is frequently confined to about what I have said, to 
look for the lesion and remove it, and then treat along the region of the spine 
where we get the nerves to the kidneys. 

P. Stimulate to increase the action, and inhibit to lessen it? 

A. Well, that brings us back to the question of just what we do when 
we stimulate or inhibit. It would depend upon the condition there whether 
I would spring the spine and work in such a way as to stimulate or whether 
I would hold. 

Q. If there was too much secretion you would not treat in the same way 
as if you wanted to increase it? 

A. I would be very likely to. I would stimulate along the region of 
the spine which shows there is some obstruction to the nerve force and my 
idea would be to remove that obstruction. 

Q. Would you pull on the neck when it is turned to one side or the 
other and turn it? 

A. I would not pull it and turn it. 

Q. I mean after it is turned. 

A. O, yes; I would not be afraid to do that. I would have the neck 
turned about in this way, and this straight pull is about the best way, but I 
would not pull it and turn it, because you are likely to cause trouble. The 
parts are more apt to be stretched, and you may get an articular process out 
of place. 

Q. In varicose veins, what would you do other than manipulate the 
nerves and the limbs? 

A. I would work along the lower region of the spine, and stimulate the 



208 

sacral nerves, and I would stretch the leg thoroughly, and stimulate the 
sciatic, since the sciatic contains the vaso- motor nerves for the limbs; then at 
the saphenous opening, I would loosen that as I have already told you how 
to do, and I would work upward from the varicose veins along the course of 
the veins to stimulate the flow of blood. Do everything to build up the tone 
of the limb. The trouble may be somewhere else, but it is most frequently in 
the legs, from standing on the feet too much. 

Q. How would you treat neuralgia of the heart? 

A. I would confine myself there to the upper dorsal region. I would 
go to that region first and would give the heart all the room to play in that 
it needed, then I would inhibit at the superior cervical region with the idea 
of inhibiting the nerve force and quieting the spasm if possible. You can do 
anything to reach the nerve force and quiet it. It is evidently excited dud 
there is evidently some irritation. Your idea is to find the cause of the ir- 
ritation and remove it if possible. It may be caused by some poison in the 
system, then you would have to remove the original cause by general treat- 
ment. Dr. McConnell says the trouble is frequently in the costal cartilages. 

Q. How would you treat cerebral troubles? 

A. Through the neck, it depends upon the case, of course. 

Q. In hay fever would the treatment be anything different from that for 
general fevers? 

A. Yes, look for the lesion in the superior cervical region or in the upper 
dorsal, sometimes the first rib is at fault, sometimes the clavicle, and you 
must look for the lesion in those places. We do not have the ordinary symp- 
toms of fever in hay fever, it is a catarrh. 

Q. How would you treat for lumbago? 

A. I would relax everything along the spine, especially in the lower 
part; first by working the muscles, then by flexing the knees against me, then 
I would put the patient into a chair and lift up and turn as I lifted. I think 
the theory is that the tension of the ligaments there is affecting the nerves 
and causing the stiffness of the muscles, I have seen several cases treated in 
that way and very successfully. 

Q. How would you treat appoplexy? 

A. It depends upon general causes and conditions generally. That is, 
it generally occurs in elderly people, where they are not used to much exer- 
cise and after they have run for a train or to a fire, they get their hearts ex- 
cited and their vessels being weak and the general tone of their system being- 
relaxed, there is a break of a small capillary in the brain and the formation of 
a clot, and perhaps it does not extend farther than congestion of the brain. 
Sometimes it is in cases of people who have long been bothered with conges- 
tion, and the blood does not circulate properly through the brain or the bod> , 
and too much is thrown to the head. Von would have to relievt^ the ueneral 



209 

causes, and you must in some way call the overplus of blood from the head, 
and in that case you would treat over the superior cervical region particu- 
larly, and then to get your effect you would have to work over the solar 
plexus and the splanchnics to draw the blood from the head. That in general 
is the treatment. Of course you understand these are just snap shots, I can- 
not say much on any of these subjects here. What I have said is simply as 
far as my knowledge has gone. 

Q. Is catarrhal fever treated the same as catarrh? 

A. Well, hardly, you would have to go further than the general treat- 
ment for catarrh. Catarrhal fever is a name applied to catarrh when it has 
extended to the stomach, and you have a bilious fever or gastric fever. You 
must work then for the nerve centers for the stomach, and thoroughly free 
them up. I have had a case of that and had very goad success with it. They 
usually have a stitch in the side. I do not know what causes it, that is one 
of the symptoms. My treatment was to stimulate the stomach and intestines 
in all parts and work through the superior cervical region. 



208 

sacral nerves, and I would stretch the leg thoroughly, and stimulate the 
sciatic, since the sciatic contains the vaso-motor nerves for the limbs; then at 
the saphenous opening, I would loosen that as I have already told you how 
to do, and I would work upward from the varicose veins along the course of 
the veins to stimulate the flow of blood. Do everything to build up the tone 
of the limb. The trouble may be somewhere else, but it is most frequently in 
the legs, from standing on the feet too much. 

Q. How would you treat neuralgia of the heart? 

A. I would confine myself there to the upper dorsal region. I would 
go to that region first and would give the heart all the room to play in that 
it needed, then I would inhibit at the superior cervical region with the idea 
of inhibiting the nerve force and quieting the vSpasm if possible. You can do 
anything to reach the nerve force and quiet it. It is evidently excited and 
there is evidently some irritation. Your idea is to find the cause of the ir- 
ritation and remove it if possible. I^ may be caused by some poison in the 
system, then you would have to remove the original cause by general treat- 
ment. Dr. McConnell says the trouble is frequently in the costal cartilages. 

Q. How would you treat cerebral troubles'? 

A. Through the neck, it depends upon the case, of course. 

Q. In hay fever would the treatment be anything different from that for 
general fevers? 

A. Yes, look for the lesion in the superior cervical region or in the upper 
dorsal, sometimes the first rib is at fault, sometimes the clavicle, and you 
must look for the lesion in those places. We do not have the ordinary symp- 
toms of fever in hay fever, it is a catarrh. 

Q. How would you treat for lumbago? 

A. I would relax everything along the spine, especially in the lower 
part; first by working the muscles, then by fleeing the knees against me, then 
I would put the patient into a chair and lift up and turn as I lifted. I think 
the theory is that the tension of the ligaments there is affecting the nerves 
and causing the stiffness of the muscles, I have seen several cases treated in 
that way and very successfully. 

Q. How would you treat appoplexy? 

A. It depends upon general causes and conditions geneially. That is, 
it generally occurs in elderly people, where they are not used to much exer- 
cise and after they have run for a train or to a fire, they get their hearts ex- 
cited and their vessels being weak and the general tone of their system beiiiu- 
relaxed, there is a break of a small caj^illary in the brain and the formation of 
a clot, and perhaps it does not extend farther than congestion of the brain. 
Sometimes it is in cases of people who have long been bothered with conges- 
tion, and the blood does not circulate properly through the brain or the body, 
and too much is thrown to the head. Vou would have to relieve the ii'eneral 



209 

causes, and you must in some way call the overplus of blood from the head, 
and in that case you would treat over the superior cervical region particu- 
larly, and then to get your effect you would have to work over the solar 
plexus and the splanchnics to draw the blood from the head. That in general 
is the treatment. Of course you understand these are just snap shots. I can- 
not say much on any of these subjects here. What I have said is simply as 
far as my knowledge has gone. 

Q. Is catarrhal fever treated the same as catarrh"? 

A. Well, hardly, you would have to go further than the general treat- 
ment for catarrh. Catarrhal fever is a name applied to catarrh when it has 
extended to the stomach, and jou have a bilious fever or gastric fever. You 
must work then for the nerve centers for the stomach, and thoroughly free 
them up. I have had a case of that and had very goad success with it. They 
usually have a stitch in the side. I do not know what causes it, that is one 
of the symptoms. My treatment was to stimulate the stomach and intestines 
in all parts and work through the superior cervical region. 



R D 174 








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